CREDIT ACCOUNT APPLICATION FORM

Information submitted in this form is not held on a database. It is for customer printing purposes only. When completed please print, sign and return to Active Sensors Accounts Department: accounts@activesensors.com

Customer details

Company name:
Address:
Zip/Post code:		Country:
Tel no:		Fax no:
Contact:		Email:
Accounts contact:		Accounts email:

Bank details

Bank name:
Address:
Company registration no:		Sort code:
Number of years trading:		Account no:
VAT no (if applicable):		Account name:

Trade references

	1st Supplier name and address		2nd Supplier name and address
Name:		Name:
Address:		Address:
Zip/Post code:		Zip/Post code:
Country:		Country:
Tel No:		Tel No:
Fax No:		Fax No:
Contact Email:		Contact Email:

Name:

Position:

Date:

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