Credit Account Application

Company details

Trading name*

Limited company name

Address line 1*

Address line 2

Town / City*

Postcode*

Date business started*

Company telephone*

Mobile telephone

Website

Invoice email*

Accounts email*

Company registration number*

Registered office address

(If different to above address)

Address line 1

Address line 2

Town / City

Postcode

Business information

Annual turnover*

Number of employees*

Type of business*

Credit request

Credit value requested (£)*

Bush Tyres representative*

Order numbers required on all invoices

Trade reference 1

Contact name*

Company name*

Email*

Telephone*

Address line 1*

Address line 2

Town / City*

Postcode*

Trade reference 2

Contact name*

Company name*

Email*

Telephone*

Address line 1*

Address line 2

Town / City*

Postcode*

Declaration & signatures

I/We confirm that the information given above is true and complete, and I/We agree to Bush Tyres' terms and conditions of trading.

Claims arising from invoices must be made within seven working days.
All invoices must be paid with-in terms (30 days EOM), invoices not paid to terms stated will result in the account being placed on stop and may result in being passed to our 3rd party collection agency.
By submitting this application, you authorise BA BUSH AND SON LTD to make inquiries into the business/trade references that you have supplied.

Signatory 1 name*

Date*

Signatory 1 signature*

Sign in the box above using your mouse or finger.

Signatory 2 name

Date

Signatory 2 signature

Sign in the box above using your mouse or finger.