Credit Account Application Form - Golden Coast

Account Application Page 1 of 3

Account Type

 Credit account

 Pro forma account

(if you require a credit account, please complete page 3)

Company Details Full trading name: Registered address:

Postcode:

Phone:

Fax:

Email:

Mobile:

Accounts Details Accounts address (If different):

Postcode:

Phone:

Fax:

Email:

Mobile:

Delivery Details Delivery address:

Postcode:

Phone:

Fax:

Email:

Mobile:

Document Emailing All Golden Coast documentation is sent to customers by email. Please therefore specify an email address where indicated below. (We can only accept one email address under each criteria). Sales order documentation email (Quotations, order acknowledgements and pro forma invoices [where applicable]): Accounts documentation email (Invoices, credits and statements) :

Business Details Nature of business: Type of business (Ltd company, Sole Trader, Partnership): Company registered number:

VAT registered number:

Company secretary:

Number of years trading:

Revised 21.10.2013

Anticipated monthly trading with Golden Coast: £

Golden Coast Ltd | Fishleigh Road | Roundswell Commercial Park West | Barnstaple | Devon | EX31 3UA Phone: +44 (0) 1271 378100 | Fax: +44 (0) 1271 371699 | Email: [email protected] | Web: www.goldenc.co As a quality assured company we reserve the right to alter and improve the specification of products as deemed necessary. Registered in England and Wales 2420044 VAT Reg. No 540 4110 02


Directors/Partners/Proprietors Name:

Date of birth:

Address:

Postcode:

Name:

Date of birth:

Address:

Postcode:

Name:

Date of birth:

Address:

Postcode:

Declaration and Data Protection Notice I/we confirm that the information given in this Account Application form is in all respects true and accurate. I/we confirm that I/we have read and understood your terms and conditions of business (which can be found at www.goldenc.co/resources/web_terms-conditions) and I/we unconditionally accept those terms and conditions shall be the only ones that apply to all sale contracts which I/we may conclude with you.

 I confirm I have read the terms and conditions of business. Data Protection Act 1998 Notice Words shown in italics are defined in the Data Protect Act 1998. Where I/we provide you with personal data (“data”), I/we understand that the data will be held securely in confidence and processed for the purpose of carrying out your business and associated activities (“activities”). In considering my/our application, I/we accept that you may consult with and disclose the data to credit reference agencies, banks, credit insurers and other responsible organisations outside your business that you have nominated (“third parties”), and that such third parties may process the data. I/we understand that under the Act I/we have a right to know what data you hold on me/us if I/we apply to you in writing and pay the applicable fee. I/we agree that you may use the data to contact me/us with details of other products and services. Unless I/we have written to you objecting to you using the data for such purpose or I/we have ticked the box below, I/we agree that you may contact me/us by post, telephone, fax, email, via the internet, or other communication means.

 I/we object to you using the data for direct marketing purposes.

Should this box be ticked, you will not receive items such as price lists, details of special offers, promotions or the Golden Coast newsletter.

Authorised signature of applicant(s): Printed name:

Date:

Revised 21.10.2013

Capacity in which signed:



Credit Account Trade References Company:

Contact:

Address:

Postcode:

Phone:

Fax:

Email: Company:

Contact:

Address:

Postcode:

Phone:

Fax:

Email: Company:

Contact:

Address:

Postcode:

Phone:

Fax:

Email:

Notes

Revised 21.10.2013

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