Contact
First name
*
Surname
*
E-mail
*
Role
*
Telephone (direct line) or mobile number
*
Company
Company name
*
Does the company trade under a different name?
*
Yes
No
Trading name
*
Company telephone number
Invoicing address
*
Trading / delivery address
*
Same as above
Another address
Trading / delivery address
*
Company type
*
Limited company
Partnership
Sole trader
Other
Please specify company type
*
Company registration number
*
VAT number
*
Part of subsidiary?
*
Yes
No
Parent company name
*
Is the company authorised to obtain goods and services at the zero rate of VAT?
*
Yes
No
Please attach a copy of Form VAT 13B (if applicable)
Do you require credit? (Please note: if you select 'no', you'll be setup with a prepaid cash account, payment prior to dispatch)
*
Yes
No
Credit terms are generally only available after a period of pro forma prepaid trading, and after a certain level of business has been achieved.
*
Yes, we'd like to proceed with a Credit Application.
No, we don't require credit at this time. A prepaid cash account is sufficient.
Credit Application
Names and positions of company directors
*
Issued capital
Years traded
*
Does the company have any County Court Judgements registered against it?
*
Yes
No
Please provide details of County Court Judgements
*
Premises
Leasehold
Freehold
Please attach a photo or scan of the company letterheaded paper
Please attach the latest signed audited accounts (if available)
Please state annual turnover for each of the last 3 years
*
Maximum monthly credit required
*
Currency
*
Accounts contact
*
Accounts contact phone number
*
Accounts contact email
*
Bank details
Bank name
Bank address
Bank telephone number
Bank sort code
Bank account number
Number of years this bank has held the company account
Trade references
To offer credit terms, we will require two trade references. Some companies don't issue trade references, so please double check before listing a company in this section.
*
Ok
Trade reference 1
Trade reference 1: Company name
*
Trade reference 1: Company address
*
Trade reference 1: Contact person, email, and phone number
*
Trade reference 2
Trade reference 2: Company name
*
Trade reference 2: Company address
*
Trade reference 2: Contact person, email, and phone number
*
Agreement
By submitting this form, you hereby certify that:
All information contained within is complete and accurate. You have the authority to act on behalf of the credit applicant. You will make settlements of accounts within agreed credit terms. You accept that “Title of Goods” supplied remain with Videnda Distribution Limited until paid in full. You accept the standard conditions of sale of Videnda Distribution Limited, as amended from time to time. In accordance with GDPR, you consent to and authorise Videnda Distribution Limited to process and retain data provided in respect of this application. Data will not be shared outside of the company, and will not be used for marketing purposes.
Confirmation that you agree to the above terms and conditions
*
I agree
Submit
Should be Empty: