Credit Application Form

This Credit Account Application Form (the Form) sets out particulars of the credit account which North West Timber Treatment Limited (registered company number 01993494) whose registered office is at NWTT House Lockett Road, South Lancs Industrial Estate, Ashton In Makerfield, Wigan, WN4 8DE (NWTT) is willing to offer credit on if the application of the customer whose details are set out below (the Customer) is successful. The terms and conditions applicable to the credit account (the account terms) are enclosed herewith and must be accepted by the customer before making the application and being granted a credit account. The Account Terms can be found here.

BUSINESS DETAILS

Business Name

Business Type

Company

LLP

Partnership

Sole Trader

Corporate Registered Number (if applicable)

Registered / Business Address

BUSINESS CONTACT DETAILS

Name

Email Address

Telephone Number

Fax Number

DETAILS OF DIRECTORS / PARTNERS / CONTROLLING INDIVIDUAL

Name

Contact Details

Position Held

Personal Guarantee*

ADDITIONAL CONTACTS (IF APPLICABLE)

Name

Contact Details

Telephone Number

Personal Guarantee*

Name

Contact Details

Telephone Number

Personal Guarantee*

*Where a personal guarantee is being provided by the individual(s) named above, for the purposes of the Account Terms they shall be referred to as 'the Guarantors' and each 'a Guarantor'.

DETAILS OF PURCHASE CONTACTS

Name

Company Email Address

Phone Number (please include extension no. if applicable)

Role within company

ADDITIONAL PURCHASE CONTACTS IF APPLICABLE

Name

Company Email Address

Phone Number (please include extension no. if applicable)

Role within company

Name

Company Email Address

Phone Number (please include extension no. if applicable)

Role within company

CREDIT LIMIT

Credit Limit (£ per month)

Details of Two Trade References

Please provide the details of two third parties which have offered credit to you previously, in order for pre-credit checks to be carried out.

Name

Address

Postcode

Telephone

Name

Address

Postcode

Telephone

PAYMENT

Preferred Method of Payment

Bank Debit Card

BACS

Bank Details

Name

Account No

Address

Sort Code

SIGNATURE

The legally binding contract between the parties on which basis the credit account and future contractual dealings between the parties are based is comprised of: a) this form, b) the Account Terms, c) NWTT's Standard Terms and Conditions of Sale (the Sale Terms) and d) any other documents referred to in any of the aforementioned, (together, the Agreement).

Prior to this agreement coming into force, you must tick the box below and NWTT must signify its acceptance of the application in writing. By ticking the box below, I hereby warrant that I am duly authorised to do so for and on behalf of the customer and have read, understood and agree to any and all terms and conditions comprising this agreement.

I accept the Terms & Conditions

Full Name

Date

Company Letterhead

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In processing your application for credit facilities we may make enquiries of credit reference agencies and other third parties who may record those enquiries. We may also disclose information about the conduct of your account to credit reference agencies and other third parties. The information obtained from or provided to credit reference agencies or other third parties may be used when assessing further applications for credit terms, for debt collection, for tracing and for fraud prevention. I, the undersigned hereby confirm that if credit facilities are approved the account will be paid as per your normal monthly terms 30 days, and I guarantee, jointly and severally, to indemnify you for any amount outstanding from time to time on the said account, in the event of non-payment by the company, in whose name such credit is hereby sought. I also agree personally and on behalf of the company, to pay interest at the rate of 3% above base rate per annum on amounts outstanding for more than 60 days.