Company Account Application Form


Company Details
Ledger Contact Information
Delivery Contact Information
Ordering Contact Information
Trade References


Legally Responsible Contacts To Be Completed By Trustees/Owners/Tenants/Members/Secretaries/Treasurers
Declaration

the undersigned agree to the Terms and Conditions of trade and confirm that the information given is correct to the best of our knowledge.
further agree that unless confirmed in writing by Alliance Disposables Ireland Ltd, we will adhere to the payment terms of 30 days from date of invoice.

Direct Debit
Alliance National

Instruction to your bank or building society to pay by Direct Debit

Instruction to your bank or building society
Please pay Alliance Disposables Limited Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Alliance Disposables Limited and, if so, details will be passed electronically to my bank/building society.
Clear Signature
Clear Signature

The Direct Debit Guarantee
  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
  • If there are any changes to the amount, date or frequency of your Direct Debit Alliance Disposables Limited will notify you ten working days in advance of your account being debited or as otherwise agreed. If you request Alliance Disposables Limited to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
  • If an error is made in the payment of your Direct Debit, by Alliance Disposables Limited or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society - If you receive a refund you are not entitled to, you must pay it back when Alliance Disposables Limited asks you to
  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Alliance National is committed to protecting the privacy of individuals. If you provide us with personal details about yourself, we will NOT pass that information to any other third party unless required to do so by law. To find out more about how we use your personal information, please see our Privacy Policy.