Please complete all fields below. Fields marked with a * are required.

A copy of this form will be sent to you and our accounts department.

Vygon Credit Application Form

Trading name and address of account:

Company Name

Contact Name

Address 1

Address 2

Town/City

Postcode

Tel. No (Include Area Code)

Address to which invoices are to be sent

Invoice address is same as above

Yes

Company Name

Contact Name

Address 1

Address 2

Town/City

Postcode

Tel. No (Include Area Code)

About The Business

VAT No. if registered

Company Registration No

Type of organisation (e.g. Sole partnership, partnership, Private etc)

Main Activity

Name and address of ultimate holding company

Is the name and address of the ultimate holding company different from the above?

Yes

Company Name

Contact Name

Address 1

Address 2

Town/City

Postcode

Company Registration No

No. of employees in group

No. of locations/premises

Extent of Credit Required

Estimated value of annual purchases by you (£)*

Please state the amount of credit required (£)*

*Enter below how the amounts have been estimated (details of products/services required for period)

Authorised Personnel

Person(s) authorised to place orders on your behalf (enter name and job title)

Trading Terms: Nett 30 Days from Invoice Date

Declaration By Applicant

I/We hereby request you to open a credit account and I, being an authorised signatory of this organisation, agree that payment of all accounts will be received by you (as the supplier) within your stated credit terms and acknowledge that our adherence to this obligation is the essence of the contract between us.

I agree with the Vygon terms and conditions of sale (click here to view). A copy will also be sent to your email address after submission.

I agree to the Terms & Conditions set out above