Simple Credit Account Application Form

If you are dealing with a new customer who wants to establish a line of credit then it is vital that you begin the credit management process at the earliest possible date. Ask for the basic information that you will need in order to assess whether the risk you are taking in providing them with credit is commercially viable.
At Account opening stage the business has three objectives:
1. To establish the correct identity of the customer.
2. To confirm that customer's ability to pay.
3. To agree Trading Terms.
These objectives are not difficult to achieve. A simple Credit Account Application Form can be used to obtain information, and to set out, on the reverse, the supplier's Terms of Trading. By signing the completed Form, the customer provides the information and agrees the Terms.

Application for a credit facility

Items in this box are for office use only Date Received _______

New Account	Change of Address	Close Account	Change of Title

To be completed by [Customer] [Supplier/ Sales Representative] Full Legal Title and Trading Name : _________________________________
Sole Trader	Partnership	LLP (please tick where appropriate)
Limited Company	Co. Reg. No.		PLC

Delivery Address

Name

Street

Town

Country

Postcode Phone Number

Statement Address (if same as delivery address, please state)

Name

Street

Town

Country

Postcode Phone Number

Business Activity (please specify __________________________________

Method of Payment :

Cheque

Direct Debit

BACS

Other

If other please specify: __________________________________

I/We request you to open a Credit Account in the name of:
___________________________________________________

With a Proposed Credit Limit of: _______________ per month
Including VAT: ______________________________per month
Agreed Credit Period : ________________________days

Trade References
I/We authorise you to take up references at any time from the under mentioned bank and trade sources (we will make searches with a credit reference agency, which will keep a record of those searches and will share that information with other businesses. We may also make enquiries about the principal directors with a credit reference agency.):

1. Name __________________________________ Account Number________________
Full Address_____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

2. Name __________________________________ Account Number_______________
Full Address_____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

3. Name __________________________________ Account Number________________
Full Address_____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Bank Details
Name __________________________________________________________________
Address_________________________________________________________________
Sort Code_______________ Account Number___________________________________

Contact for Payment
Name __________________________________________________________________
Position_________________________________________________________________
Tel No._______________ Fax No. ____________________________________________

Details of Owner/ Partners/ Directors

We have read, understood and retained a copy of your conditions of sale (including the retention of title clause) and agree to trade in accordance with these for any goods supplied. We accept that title to all goods supplied to us will remain vested in [ ] Limited until all amounts outstanding from us on any account have been paid in full to [ ] Limited.

I/We also agree to comply with your settlement terms (specified within your conditions of sale).

I attach a sample of my/ our headed paper with this form.

1. Name __________________________________ Signature______________________
Home Address____________________________________________________________
________________________________________________________________________

2. Name __________________________________ Signature______________________
Home Address____________________________________________________________
________________________________________________________________________

3. Name __________________________________ Signature______________________
Home Address____________________________________________________________
________________________________________________________________________

Customer Visit Report

(to be completed by Supplier/ Sales Representative.)
(This report should contain key information about a prospective new customer i.e. length of time in business, size of business, where they have previously purchased goods from, financial information etc.)

Signature____________________________________________ Date__________________

Credit advice

Credit application form