Company Details

Customer Id

FULL COMPANY NAME *

TRADING AS  *

ADDRESS *

POST CODE *

TELEPHONE *

FAX

COMPANY REG. NO. *

VAT NO.

BOND/DUTY EXCISE NO.

WOWGR REG.NO.

AWRS NO.

TYPE OF OUTLET

Select Type Of Outlet WHOLESALER OFFLICENCE SUPERMARKET RESTAURANT BAR

Personal Details FULL NAMES & PRIVATE ADDRESSES OF OWNERS / DIRECTORS / PROPRIETORS

NAME

ADDRESS

POST CODE

EMAIL ID

Bank Details

BANK NAME

ADDRESS

POST CODE

SORT CODE

ACCOUNT NO.

IBAN NUMBER

SWIFT CODE

COMPANY OWNERSHIP SELECT AS APPROPRIATE

Select Company Ownership SOLE TRADER PARTNERSHIP LIMITED COMPANY

Invoice Detail

ADDRESS

POST CODE

FAX

TRADE REFERENCE 1

REFEREE NAME *

ADDRESS

POST CODE *

TELEPHONE / FAX

CONTACT NAME

TRADE REFERENCE 2

REFEREE NAME *

ADDRESS

POST CODE *

TELEPHONE / FAX

CONTACT NAME

DOCUMENT REQUIRED PLEASE ATTACH COPIES OF THE FOLLOWING DOCUMENTS FOR OUR DUE DILIGENCE PROCESS, IN LINE WITH HMRC SECTION 726 REQUIREMENTS

LETTERHEAD

 

CERTIFICATE OF INCORPORATION

 

WOWGR CERTIFICATE

 

DIRECTORS’ PASSPORT

 

UTILITY BILL

 

VAT CERTIFICATE

 

OTHER DOCUMENTS

 

CUSTOMER DECLARATION THIS DECLARATION PRECLUDES ANY TERMS OF PURCHASE MY COMPANY MAY ATTEMPT TO IMPOSE

1

I / We the undersigned declare that the above details are correct and that I / We have seen, do understand and agree to accept the CONDITION OF SALE printed on the reverse side of this document.

2

I / We understand that this form does not constitute agreement by,DJD INTERNATIONAL BRANDS LIMITED to open a direct account or to supply goods on a credit basis

DATED

NAME*

POSITION*

WITNESS

ACC MRG