Fields marked * are mandatory

Which Bristol & Avon Company would you like to open a credit account in?

Waste Management
Transport & Recycling
Land Remediation

* Company Name

* Company Address

* Registered Office (if different from above)

* Telephone Number

* Fax Number

* Company Reg. Number

* VAT. Number

* Date Business Formed

* Trade Contact Name

* Trade Contact Telephone Number

* Email

Two trade references with addresses, Tel. No’s, & Contact names

(Please do not use Travis Perkins or Fuel Companies as a reference)

* Trade Reference 1

* Trade Reference 2

* Person responsible for account payment

* Position within company

* Telephone Number

* Fax Number

* Credit Limit requested

* Anticipated monthly spend

Have you dealt with our company previously in any capacity?

(ie another firm under a different name, as an employee of a customer of ours etc.)

If YES please give details

DECLARATION BY APPLICANT

I/We hereby apply to open a credit account. I/We declare that the above details are true and correct to the best of my/our knowledge. I/We authorise you to approach a credit reference agency, bank and referees.

I/We undertake to pay in full any monies due in accordance with your stated credit terms.

I/We further agree to abide by your terms and conditions and understand this is the essence of the contract between us.

* Name

* Date