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< Electrical Components < Credit Application

Credit Application Form

Thank you for applying for a Credit Account with Aerco. By completing all the sections in this form you will be helping us to deal with the application quickly and efficiently, and will enable us to ensure that our invoices, statements and deliveries are correctly addressed.

We have pre-filled as many of the sections on this form as we can. We normally use a credit reference service to help us assess applications for credit accounts. For higher credit limits we may also apply for references to your bank and two other companies with which you trade.

* = Required Fields

Full Name of Company: *

Number of years trading:

Company Address: *
(to send quotations and acknowledgements)

Post/Zip Code: *

Name of procurement department contact:

Name of accounts department contact: *

Email Address: *

Telephone Number: *

Fax Number: *

VAT Registration Number: *

Company Registration Number: *

Registered address of company:

Please tick this box if the same as Company Address

Address for deliveries: *

Please tick this box if the same as Company Address

Address for invoices: *

Please tick this box if the same as Company Address

Address for statements: *

Please tick this box if the same as Company Address

How did you hear about us? (please tick)

Website
Other

PR/Advertising

Referral by Supplier

Word of Mouth

Trade References

Trade Reference 1
Name of Contact:*		Fax Number:*
Company Name:*		Address 1: *
Telephone Number:*		Address 2:

Trade Reference 2
Name of Contact:*		Fax Number:*
Company Name:*		Address 1: *
Telephone Number:*		Address 2:

Credit Limit Requested

Credit Limit Amount Requested:*

Requested By Name:*

Position:*

I/we confirm that the information given in this form is in all respects true and accurate. I/we confirm that I/we have read and understood your terms and conditions of sale and I/we unconditionally accept that those terms and conditions shall be the only ones that apply to all sale contracts that I/we may conclude with you.

Data Protection Act 1998 Notice: Where I/we provide you with personal data I/we understand that the data will be held securely in confidence and processed for the purposes of carrying out you business and associated activities. In considering my/our application I/we accept that you may consult with and disclose the data to credit reference agencies, banks, credit insurers and other responsible organisations outside your that you have nominated ("third parties") and that such third parties may process the data. I/we understand that under the Act I/we have a right to know what data you hold on me/us if I/we apply to you in writing and pay the applicable fee.

Please tick this box if you agree with the Terms & Conditions