Please print the form and post it to us having completed and signed it.
Unit 5 Cortry Close, Branksome Business Park, Poole, BH12 4BQ
Tel: 01202 746000 Fax: 01202 746046
email: sales@marineelectrics.co.uk
Website: www.marineelectrics.co.uk

APPLICATION for TRADE ACCOUNT
Copy of terms and conditions of business are available upon request
Full Company Name  
Registered Address of Company  
 
 
Post Code  
Usual Delivery Address (if different from above)  
 
 
Post Code  
Telephone Number  
Fax Number  
E-mail  
Website  
Company Registration No.  
Type of Business  
Years Company Established  
Contact Name for Accounts  
Bankers Name  
Bank Address  
 
 
Post Code  
Bank Account Number  
Bank Sort Code  

I note and accept your terms and conditions of business and agree to pay for all goods and services supplied. I agree that all goods remain the property of Index Marine until payment has been received and cleared in full.

I note that all accounts are payable by the 28th day of month following month of invoice.
Authorised signature on behalf of your company  
Print Name  
Position  
REFERENCES
Name  
Address  
 
 
Post Code  
Name  
Address  
 
 
Post Code  
(issue 1)