Name:

Email:

* Website Address:

Company Name:

Company Address:

Postcode:

Company Registration no:

VAT no:

PLEASE STATE DETAILS OF ALL PARTNERS/DIRECTORS OF THE BUSINESS (if Business is not a limited company, Please state the home address of All Partners)

Name of Director 1:

* Name of Director 2:

Trade Reference 1:

Trade Reference 2:

Contact Name for orders:

Telephone:

Contact Name for Payment:

Telephone:

We will make a search with a credit reference agency, which will keep a record of that search and will share that information with other businesses. We may also make enquiries about principal directors with a credit reference agency.

I/We have read and understood the Terms and Conditions of Trading and agree to pay in accordance there-with for any goods supplied by DIRECT SOURCE LTD.

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