Account

Company Details

LTD Company Partnership Sole Trader Other

Company Name: *

Address: *

Telephone Number:

Mobile Number: *

Email Address: *

VAT No: *

Registration No: *

Date Started Trading *:

Date Company Registered *:

Delivery Address: If different from above

Contact Name: *

Telephone Number: *

Email:

Business Activity: * Please specify

Breakdown Service: *

Yes No

Number Of Vehicles: *

Car

Van

Lorry

Billing Detials

Same billing address as above Different billing address

Company Trading Name: *

Billing Address: *

Contact Name: *

Telephone Number: *

Email:

Method Of Payment

Cheque Direct Debit BACS Other

Bank Details

Bank Name: *

Address:

Account No: *

Sort Code: *

References

I/We authorise you to take up references at any time from the trade sources listed below.

We will make searches with a credit reference agency, which will keep a record of those searches.
We will not share information with other businesses unless you request us to do so.

Signature: *

Reference 1

Company Name: *

Address:

Contact No: *

Email: *

Reference 2

Company Name:

Address:

Contact No:

Email:

I/We have read, understood and retained a copy of your Terms and Conditions (including full retention of title clause).

I/We agree to trade in accordance with these for any goods supplied. I/We confirm the above details are correct.

Signature (Director/authorised Signature)

Name: *

Signature: *

Signature Date *:

Return Form: Please upload a copy of the letterhead or company stamp showing full legal company name

Select file

Contact Info

Email: barry@nwtyres.com
Address: 177 Strand Rd, Derry
Phone: 028 7126 8649

Company Details

Billing Detials

Method Of Payment

Bank Details

References

Reference 1

Reference 2

Signature (Director/authorised Signature)

Contact Info

North West Tyres Depot

Northwest Tyres: