APPLICATION FOR CREDIT ACCOUNT

Company Registration Number

VAT Reg. No.

Credit Amount Required

Company Name

Invoice Address

Post Code

Tel. No.

Fax No.

Email Address

Web Address

Trade Reference 1

Trade Reference 2

Accounts Contact Name

Accounts Payable email address

Delivery Address (if different from invoice address)

Nature of business

Parent Company Name(if applicable)

Parent Company Address

Parent Company Registration Number

Parent Company will underwrite Debt

Yes No

Payment terms are strictly net monthly from date of invoice

Easirent Limited terms and conditions apply at all times.

Bankers Name, Address & Post Code:

Account Number

Sort Code

Tel. Number:

Fax Number:

We authorise Easirent to carry out the necessary checks.

Signature: _________________ Print Name: ____________________

Position: ____________________________ Date: ________________

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