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New Account Application Ver 3
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Contact Name:
*
First
Last
Company Name:
*
Company Address Line 1:
*
Company Address Line 2:
Post Town:
*
County:
Postcode:
*
Company Type:
*
LTD / PLC
Limited Liability Partnership
Partnership
Sole Proprietor
If Ltd/PLC, Please enter Company Registration Number:
Landline Number:
Mobile Number:
*
Email
*
How did you hear about us?
Contacted by a BDM Agent
Via Facebook
Via LinkedIn
Organic Search
Others
What is your current business model?
*
Retail Shop
eCommerce
Physical Store and Online Store
Have any of the directors ever been directors of a company that became insolvent or entered into a company voluntary arrangement or have they been personally bankrupt or entered into an I.V.A.?
No
Yes
How would you like us to contact you regarding your account application? (Mark at least one)
*
By telephone
By Email
Confirmation
*
I have read the copy of Q&Y International Ltd terms and conditions of sale and accept that all sales and any credit granted will be subject to these conditions and the contents of this form at all times, and being a principal/ principals of the applicant entity, jointly and severally guarantee performance of all the entity’s financial obligations to Q&Y International Ltd and I/(we) acknowledge that further copies of the terms and conditions are available on request.
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Doc/TXNL/CS01
