PDP Services - Company Account Application Form

Business Contact Information

Registered Company Name *

Registered Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Company Registration No.

Company VAT No.

Type of Business

Business Type

Trading Name (if different to above)

Trading Address (if different to above)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Name *

First

Last

Job Title

Contact Phone

Contact Email *

Accounts Payable Contact *

First

Last

Accounts Phone *

Accounts Email *

Payment Terms

Business / Trade References (where applicable for a 14 day credit account)

Please provide two references for Companies where a credit account is held.

Company Name (Reference 1)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Company Name (Reference 2)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Agreement

1. All Invoices are to be paid within 14 days from the date of invoice where a 14 day credit account has been agreed. All other invoices are to be paid upon receipt. 2. Invoice queries must be raised within 7 days from the date of invoice. 3. By completing and returning this Account Application form you agree to PDP Services Ltd Terms and Conditions.

I have the authority to complete this form.

Name *

First

Last

Job Title

Date / Time

Date

Time