Account Form

If you prefer to fill our Aplication Form offline you can download it as a pdf file and send it later as a fax or email.

Ackerman Group Plc
15/16 Hickman Avenue
London · E4 9JG · UK
www.ackerman.co.uk

Tel:

Fax:

020 8523 1321 (Office)
020 8527 5050 (Sales)
020 8527 5020 (Accounts)
020 8527 6439
020 8503 2002

Email:

office@ackerman.co.uk
sales@ackerman.co.uk
accounts@ackerman.co.uk

Date: 13/3/2010

Application Form to Open a Credit Account.

Name / Trading Style: Address: Post Code:

Buyer´s Name: Accounts Contact Name:	Buyer´s Tel: Mob: Fax: E-Mail: Accounts Tel: Fax: Accounts E-Mail: Vat No: Reg. No:

If Different Delivery Address, please specify:
To enable us to grant you Credit Facilities, we normally need to take references from outside sources and from the Trade. This will take a short period of time but, if you need urgent delivery for the first transaction and you don't want to wait for credit clearance, would you like to pay Pro-Forma just for the first delivery?
Yes No

Bank Details:	Bank Name: Address: A/c No: Sort Code:

Trade Reference (1)	Name: Address: Post Code: E-Mail: Tel: Fax:

Trade Reference (2)	Name: Address: Post Code: E-Mail: Tel: Fax:

Declaration & Data Protection Notice by a Partner or Sole Trader.

I / We confirm that the information given in this Credit 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 sale, and I / we unconditionally accept that those terms and conditions shall be the only ones that apply to all sale contracts which I / we may conclude with you.

Data Protection Act 1998 Notice

Where I / we provide you with personal data, I / we understand that the data will be held securely in confidence and processed for the purpose of establishing an account for our establishment, in order that you can supply us with merchandise ordered by us from you. In considering my / our application, I / we accept that you may consult with and disclose the data to credit reference agencies, banks, credit insurers, other traders and responsible organisations within or outside your business, 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 we apply to you in writing.