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wholesaler application form

If you are interested in becoming a Val Spicer supplier please fill in the form below so we can process you application and contact you regarding this opportunity.

Email /

Registered Company Name /

Trading Name /

Registered Office /

Invoice Address
(if different from registered office)

Full Name of /

Director

Partner

Sole Owner

Director

Partner

Sole Owner

Director

Partner

Sole Owner

Registration Number /

Registration Date /

Nature of Business /

Name of Buyer /

Buyers Telephone /

Account Contact Name /

Contact Telephone /

Contact Fax /

Select Appropriate /

Sole Trader	Partnership
Limited Company	Plc

If Partnership / Sole Trader please state address /

And Telephone /

address Two /

And Telephone /

Trade References - Include Telephone and Fax Numbers

One /

Two /

Delarations - tick box to agree

THE APPLICANT WILL BE RESPONSIBLE FOR THE PAYMENT OF ANY INDEBTEDNESS WHEN THE ACCOUNT IS OPENED,IRRESPECTIVE OF WHO GIVES THE INSTRUCTIONS

IMPORTANT

• Completion of this application does not imply or confer credit facilities

• The company reserves the right to make further enquiries in connection with the application.

• The company reserves the right to refuse credit on trading facilities.

THE INFORMATION SHOWN IN THIS FORM IS ACCURATE IN ALL RESPECTS I/WE AGREE TO ABIDE BY THE TERMS AND CONDITIONS SHOWN IN THIS FORM AND IN THE PRICE LIST OF VAL SPICER DESIGNS AND AS MAY BE AMENDED FROM TIME TO TIME.