Trade Account Application Form

    New Account Details:

    Business Name:*
    Vat No:
    Company Registration No:*

    Invoice Address:

    Address Line 1:*

    Address Line 2:*

    Address Line 3:

    City:*

    Postcode:*

    Tel:*

    Delivery Address: (if different)

    Address Line 1:

    Address Line 2:

    Address Line 3:

    City:

    Postcode:

    Tel:

    Accounts Contact:

    Name:*

    Surname:*

    Email:*

    Direct Line Tel:*

    Buyers Contact:

    Name:*

    Surname:*

    Email:*

    Direct Line Tel:*



    References:

    Bankers:*


    Banker Email Address:*

    Trade:*


    Trade Email Address:*



    Other:

    Customer Web Address:
    How long in business?:*
    Sector?:*


    Privacy Preferences:


    Our Privacy Policy gives full detail to the use of your data.

    Lixall Hygiene Services & Workwear Ltd

    First order requirement: Invoiced on a Proforma basis
    PLEASE NOTE OUR TERMS ARE 30 DAYS FROM MONTH END ANY ACCOUNTS EXCEEDING THESE TERMS WILL BE HELD ON CREDIT STOP

    * Denotes required fields