CUSTOMER APPLICATION FOR CREDIT ACCOUNT
TERMS: Net 30 days from date of invoice

NAME OF COMPANY:
ADDRESS:
TELEPHONE NO:	FAX NO:
COMPANY REGISTRATION NUMBER:
ADDRESS OF REGISTERED OFFICE:
NAMES OF DIRECTORS:
NAME & ADDRESS OF BANK:
TRADE REF 1, ADDRESS:
TEL NO:	FAX NO:
TRADE REF 2, ADDRESS:
TEL NO:	FAX NO:
SIGNATURE:	DATE:
NAME IN CAPS:	POSITION:

THANK YOU FOR FILLING IN THIS APPLICATION FORM