Please fill in the form below to apply for a Credit Account with us. Company details Full trading title * Type of business Normal trading area Status Company Partnership Individual Address Line 1 * Address Line 2 Town/City * County Postcode * Contact details Tel. no * Mobile Fax Email address * Email address for invoices and statements All invoices and statements will be sent electronically unless requested otherwise in writing. Company registration details Company registration no. VAT registration no. Accounts contact A/c tel no. Registered office address Address Line 1 Address Line 2 Town/City County Postcode Company partners Partner 1 Name Address Line 1 Address Line 2 Town/City County Postcode Partner 2 Name Address Line 1 Address Line 2 Town/City County Postcode Trade references First reference Ref 1 Name * Address line 1 Address line 2 Town/City County Postcode Tel. no * Second reference Ref 2 Name * Address line 1 Address line 2 Town/City County Postcode Tel. no * TERMS OF PAYMENT APPROVED CREDIT ACCOUNTS ONLY Accounts are due for payment no later than the end of the month following date of Invoice. Where part of an account exceeds our Credit Terms the company (Wessex Eagle Ltd) shall deem that the total account be overdue and be entitled to demand immediate settlement of the total account. Declaration By ticking this box you agree to accept the Eagle Plant terms and conditions of hire and payment (CPA model conditions for the hiring of plant – available on our website). Please confirm you have supplied a copy of your Company letterhead paper to either our Head Office address or by email to email@example.com I confirm that unless I supply a copy of my hired in plant insurance to the Head Office address or by email to firstname.lastname@example.org then I can request to be charged Damage / Loss Waiver on all hires at the current rate – further details of which can be obtained from the hire point. Existing Prospective Customer * I have already received a prospective customer quotation.I have not received any quotations yet. CAPTCHAThis question is to prevent automated spam submissions. Math question * 3 + 3 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.