Apply For An Account : Distribution, Wholesale and Dropship Services for the UK

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Account Application

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Cash/Credit Application Form - Please allow up to 3 working days for credit account applications.

Your Information

Your Name
*

Your Telephone Number
*

Your Email Address
*

Your Position
*

Section marked ''* are required**

Company:	*
line 1:	*
line 2:
Town:
County:
PostCode:	*
Country:

Other Contacts at Your Company ?

No Yes


Buyers Name: Buyers Tel No.:	Buyers Email: Title/Position:
Accounts Name: Accounts Tel No.:	Accounts Email: Title/Position:
IT Contact Name: IT Contact Tel No.:	IT Contact Email: Title/Position:

Your Company Business Type ?

Sole Trader LTD Partnership PLC

Please provide the information below about your company and two Directors/Partners

Date of Incorporation:

Registration Number:

Company Address for Invoicing:
Click to use Company Address above

Company Registered Address:
Click to use Company Address above

Company:	*
line 1:	*
line 2:
Town:
County:
PostCode:
Country:

Company:	*
line 1:
line 2:
Town:
County:
PostCode:
Country:

Company Telephone:

Registered Office Telephone:

Company FAX:

Registered Office FAX:

Company Directors/Partners Information:

1. Full Name:
*
Full Home Address: *

Contact Number (home or mobile only): *

2. Full Name:

Full Home Address:

Contact Number (home or mobile only):

Connections with other companies: (please enter trading names and brief contact details)

Type of Account Required ?

Cash PrePay Credit

Please provide the information below about your company and two trade references

Estimated Annual Turnover:

Credit Limit Requested:

Trade Reference 1.
Company Name:

Address:

Contact Detials: (name & no.)

Contact EMail Address:

Trade Reference 2.
Company Name:

Address:

Contact Detials: (name & no.)

Contact Email Address:

Your Primary Trading Type ?

Start Up Business Dealer Retailer eCommerce Other

Other Trading Type

Primary Trading From Place: (please tick only one) *

Office/Warehouse:

Shop:

Home Based:

Other:

Your On-Line Trading Information:

Own Website:		Your Website URL:
Ebay Store:		Ebay Store Name:
Amazon Store:		Amazon Store Name:

Primary Trading From Place: (please tick only one) *

Office/Warehouse:

Shop:

Home Based:

Other:

Primary Trading From Place: (please tick only one) *

Office/Warehouse:

Shop:

Home Based:

Other:

Are You VAT Registered ?

No Yes


Enter Your VAT Number:

Additional Comments

Please enter any other information about your enquiry to 5TECH:

Information you have provided here will always be protected securely and it is not shared with any third parties other than for the purposes of arrange credit facilities for your account with 5TECH Limited.

By submitting this form you are authorising us to obtain credit and trading references based on the information you have provided, your information is protected under the Data Protection Act 1998.

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