Customer Registration Form | Queen Fresh Produce

Application For Credit Facilities

Company Details

Company Name:

Company Address:

Company Registration Number:

Company TAX Number:

How long has the Company traded?

Phone Number:

Fax:

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Contact Details

Contact Person:

Department:

Email Address:

Accounts Contact Person:

Department:

Email Address:

Contact Person 3:

Department:

Email Address:

Bank Details

Bank Name:

Bank Address

Account Number:

Trade Reference 1

Name:

Phone Number:

Email Address:

Trade Reference 2

Name:

Phone Number:

Email Address:

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Please note that

Payment Terms based on our agreement and credit insured.
Settlement details will be advised once credit is approved.
The Company reserves the right to suspend or cancel credit facilities when an account becomes overdue.
In completing this form, you confirm that the details provided are correct and that we agree to the payment terms provided.

Name

Date

Opt-In

Yes, I agree with the Terms & Conditions