Trade Account Form

Company Name

Trading As (if different)

Are you VAT Registered?

Yes No

VAT Number

Year established?

Are you a member of either of the following groups?

Cenpac (AIS) Minerva

Cenpac (AIS) Number

Are you a limited company?

Yes No

Company Reg Number

If NO please select type

Sole Trader Partnership Unlimited Company Other (please specify)

Other (Please Specify)

Partners Names, if applicable

Address Line 1

Address Line 2

Town

County

Postcode

Phone

Mobile Number

Fax

Website Address

Do you have an online shop?

Yes No

Sales Contact

Email address for sales contact

Accounts Contact

Email address for accounts contact

Type of Business

Type of Business (other)

Products Areas of Business

Product Areas of Business (other)

Do you have retail premises?

Yes No

Do you have showroom space?

Yes No

Number of employess

Number of stores

If you would like Gallery Direct to contact you regarding current promotions and events please state your preferred method?

Email Telephone Post

Where did you hear about Gallery Direct?

Payment Terms

Pro-forma 30 Days from Invoice Date

Amount of credit each month? (If a Proforma account is required, please enter 0)

I/We declare that the information above is correct at time of submission and any changes to the above details must be notified to Gallery Direct in writing.

Yes

Accept Terms and Conditions

Yes