Credit Account Application Form Private & Confidential (Our Ref )

Company Name: Trading Name:

Registered Office Trading Address:

Address:

Telephone: Fax:

Company Registration no: Vat No:

Accounts Contact: Accounts email:

Website address:

Number of years trading: Number of employees:

Annual Turnover:

Bank Name and address:

Bank sort code: Bank account number:

Trade Reference 1: Trade Reference 2:

Telephone: Telephone:

Requested monthly credit facility:

Please note: our terms and conditions of sale are attached. Please read carefully, sign below to confirm agreement and fax this form back on 01276 855958.

As an authorised representative of the Customer, I/We agree to purchase and pay for the goods in accordance with the trading terms and conditions of Mediamax. It is also agreed that all goods remain the property of Mediamax until paid for in full.

Signature: Print Name:

Date : Position :