Credit Application

Registered Business Name * Trading Name Company Registration Number VAT Registration Number Business Entity TypePlease selectPty LtdCCPartnershipSole TraderTrustOther Date Business Established Nature of Business Number of Employees

Physical Address Postal Address Telephone Business Email Address * Website

Finance Contact Full Name * Finance Contact Position Finance Contact Telephone Finance Contact Email Ordering / Operations Contact Full Name Operations Contact Position Operations Contact Telephone Operations Contact Email

Directors / Members / Partners / Proprietor Bank Name Branch Name and Code Account Holder Name Account Number Account TypePlease selectCheque / CurrentSavingsOther Years With This Bank Bank Contact Person and Telephone Trade References

Estimated Monthly Purchases Credit Limit Requested Proposed Payment TermsPlease select30 days60 daysCODOther Anticipated First Order Date Authorised Signatory Full Name * Position Held Place of Signature I confirm that I am authorised to submit this application and consent to RCS processing the information for credit assessment and account administration.