Application for credit account

* Indicates a required field.

1. Full company name *
2. Account address line 1 *
3. Account address line 2
4. Postcode *
5. Contact name *
6. Email address *
7. Telephone *
8. Fax

1. Invoice address (If different from Account Address)
2. Invoice address line 2
3. Postcode
4. Telephone
5. Fax
6. Business type *

   Limited Company Partnership Sole trader
7. Ltd Co. Reg. No.

8. Please enter Ltd Company Registration Number if you selected Limited Company

9. VAT Registered? *

   Yes No
10. VAT No. (if applicable) *

1. Bank
2. Address line 1
3. Address line 2
4. Account no.
5. Account name
6. Sort code

Full name, full address & date of birth of each proprietor or partner if not a Limited Company or the same details for each Director, (if there are three Directors or less), if a Limited Company.

1. 1. 1. Name
   2. Date of birth /  / 
   3. Address line 1
   4. Address line 2
   5. Postcode
2. 1. 2. Name
   2. Date of birth /  / 
   3. Address line 1
   4. Address line 2
   5. Postcode
3. 1. 3. Name
   2. Date of birth /  / 
   3. Address line 1
   4. Address line 2
   5. Postcode

If you have been at your present home address for less than 3 years please provide details of your previous address

1. 1.
2. 2.
3. 3.

1. Age of business * Years Months
2. No. business locations *
3. Geographic coverage *

   Local Regional National
4. No. employees *

   1-4 5-20 21-99 100-500 500+
5. Annual turnover (£) *

   0-2k 2-5k 5-10k 10-20k 20-50k 50-100k 100-250k 250-500k 500k-1m 1m+
6. No. of Electricians / Installers *
7. Type of business *

   Contractor / installer Facilities management Industrial

1. Name of account
2. Account number

1. If you are part of a Group Company, please provide name:
2. Estimated required monthly spend £:

1. Customer Name *
2. Position

1. Select a branch * Select branch Boston Braintree Bury St Edmunds Cambridge Great Yarmouth Ipswich Kings Lynn Luton Norwich Peterborough Spalding Wisbech Burton On Trent Chesterfield Crewe Derby Ilkeston Leicester Mansfield Milton Keynes Northampton Nottingham Tamworth Bermondsey City Croydon Docklands Feltham Grays Park Royal Reading Romford Sevenoaks Slough Tottenham Blyth Durham Newcastle (Gateshead) Newcastle (Heaton) Stockton On Tees Birkenhead Blackburn Bootle Burnley Carlisle Chester Ellesmere Port Lancaster Liverpool Oldham Preston Rochdale Runcorn Salford Salford (SPOC) Stockport Warrington Wigan Belfast Coleraine Portadown Aberdeen (North) Arbroath Ayr Dundee Dunfermline Edinburgh Edinburgh West Falkirk Fort William Glasgow Glasgow (North) Hamilton Inverness Kelso Kirkcaldy Kirkwall Lerwick Livingston Motherwell Oban Perth Ross Oil & Gas Stirling Ashford Basingstoke Canterbury Crawley Dartford Eastbourne Gravesend Guildford Maidstone Oxford Rochester Southend On Sea Andover Bath Bristol Cheltenham Exeter Newton Abbot Plymouth Portsmouth Salisbury Southampton Yate Yeovil Bangor Bridgend Cardiff Carmarthen Newport (Gwent) Pembroke Dock Swansea Wrexham Birmingham Birmingham Industrial Cannock Coventry Dudley Hereford Kidderminster Lichfield Shirley (Solihull) Shrewsbury Stoke On Trent Telford Wolverhampton Worcester Bradford Doncaster Harrogate Huddersfield Hull Leeds Scunthorpe Sheffield Wakefield York

1. Declaration

   I/we hereby apply for a credit account and in consideration of you considering our application for credit we agree that Rexel’s Terms & Conditions of Sale and any amendments or revisions thereof from time to time in force, including terms as to payment.

2. Credit Checks

   Searches with credit reference agencies may be undertaken in relation to this application and whilst you hold a trade account with us. The agencies will keep a record of that search and will share that information with other businesses. We may also make enquiries about the principal directors/partners/proprietors with credit reference agencies. We may monitor and record information relating to your trade performance and such records will be made available to credit reference agencies, who will share that information with other businesses in assessing applications for credit and fraud prevention, Under the Data Protection Act, you have the right to apply for a copy of the information we hold on individuals ( for which we may charge a small fee) and to correct any inaccuracies. Due to training requirements, some telephone calls may be monitored.

3. Agree to our terms *

   Tick to confirm that you:

   • have read the Terms & Conditions of Sale;
   • are authorised to submit this application; and
   • are authorised by the applicant and each director/partner/principle to consent to credit checks being carried out.
4. Submit