LTD / PLC / LLP Account Application Form

COMPLETION OF THIS FORM DOES NOT GUARANTEE A CREDIT ACCOUNT FACILITY; ALL APPLICATIONS ARE SUBJECT TO A CREDIT ASSESSMENT PROCEDURE

Company Details

Company Name

Trading Name (If different)

Delivery Address

Are there any delivery restrictions (Such as delivery times, gate codes, height restrictions)

Invoice Address If different to delivery address

Company Status

Company Registration No.

VAT Number

Date of Incorporation

Director Name(s)

Registered Office If different to delivery or invoice address

Part of a Group

Other Account Numbers / Names with us?

Type of Account Required

Business Type

Ledger Contact Information

Name

Phone Number

Position

Delivery Contact Information

Name

Phone Number

Position

Ordering Contact Information

Name

Phone Number

Position

Trade References

Name

Contact Name

Phone Number

Address

Name

Contact Name

Phone Number

Address

Name

Contact Name

Phone Number

Address

Add

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 Ltd, we will adhere to the payment terms of 30 days from date of invoice.

Signed

Clear Signature

Printed Name

Position

Phone Number

Email Address

Date Signed

Direct Debit

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

Name of account Holder(s)

Branch sort code

Bank/building society account number

Name and full postal address of your bank or building society

Service User Number

FOR ALLIANCE DISPOSABLES LIMITED OFFICIAL USE ONLY
This is not part of the instruction to your bank or building society

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.

Reference

Date

Account Signatory 1

Clear Signature

Account Signatory 2

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.

Please note that we may be in touch with any queries regarding your application

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.