Company Name (required)
Trading Name (if different)
Type of Business
BIID Member (required) Yes No
Address: (required)
Tel: (required)
Fax:
Email: (required)
Website: (Required)
Directors/Proprietors/Partners:
Number of Years Trading:
Registration No.:
VAT No.:
Bank:
Address:
Account No.:
Sort Code:
Trade Reference 1:
Tel:
Trade Reference 2:
I have read and understood the terms and conditions (which will apply to all orders) as attached and accept them in full, and hereby apply to open a pro forma trade account.
Date:
Position in Company: