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Online Credit Application Form
 

Please complete the simple application form below, then submit the form agreeing to our account terms. We will process you application ASAP and will advise you that your account has been opened. Your order will normally be dispatched within 24/48 hours of the account being opened.  All fields must be completed or your application maybe delayed.

Company/Organisation 
Address
City  
Post Code 
Telephone 
Fax
E-mail 
Accounts  Contact:
Title
Legal Status of Company

Sole Trader/Partnership/ PLC / Private Limited Company
Company Registration No.
Credit Limit Requested
Please state Home Address(es) if a Sole Trader or Partnership
1st Applicant:  Date of Birth (Sole Trader/Partnerships only)
2nd Applicant:  Date of Birth (Sole Trader/Partnerships only)
Name of Person making the application on behalf of the company
Title
 

Please open a credit account on our behalf and I accept your invoice terms of Nett 30 days. I hereby authorise Chemiclean Products to obtain a credit reference or a personal consumer credit reference, if the business is a sole trader or partnership. I understand that N2Check Credit Services will be employed to obtain this credit reference and will keep a record of this information.

 

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