NIC Account Form

NIC Account Form
COMPANY NAME *
PHONE NUMBER *

Area CodePhone Number
MOBILE NUMBER

Area CodePhone Number
EMAIL*
example@example.com
WEB ADDRESS
www.example.com
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal CodeCountry
TYPE OF BUSINESS *
COMPANY REGISTRATION NUMBER
EORI NUMBER*
VAT NUMBER
NUMBER OF YEARS TRADING *
HOME OR REGISTERED OFFICE ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal CodeCountry
DELIVERY ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal CodeCountry
DELIVERY TIMES*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
DELIVERY INSTRUCTIONS
How did you hear about us?*

ExhibitionAccount ManagerGoogleMagazineRecommendationSales OfficeLorrySocial MediaReturning CustomerOther
ORDER NUMBERS REQUIRED

YESNO
CERTIFICATE OF CONFORMANCE

YESNO
PAYMENT METHOD

BACSCHEQUECARD
ANNUAL TURNOVER £
CREDIT LIMIT REQUIRED *

CONTACT DETAILS *

TRADE REFERENCES *

BANK ACCOUNT DETAILS *

I/WE AGREE THAT NIC ICE LTD MAY APPLY TO MY/ OUR BANK IN ORDER TO SEEK A REFERENCE SHOULD IT BE NECESSARY*

YESNO
CONTACT PERMISSION We'd love to send you exclusive offers and the latest products and info from NIC ICE LTD by email, post, SMS, phone and other electronic means. We'll always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes.*

Yes please, I'ld like to hear about offers and servicesNo thanks, I dont want to hear about offers and services.
POSITION*
Signature*

Clear
Should be Empty: