Details of client account

Please complete the following form. Note that fields marked [ ] are required and must be completed.

Company name  
Full address
(inc postcode)		  
Delivery address
(If different)
Co. Reg. No.
Years Est.  
Bus. Type  
Tel. No.  
Fax No.
Main Contact  
Payment method Cheque Bacs


References

Please provide details of two trade references.

1st company name
Full address
(inc postcode)
Tel. No.
Fax No.
Main Contact
2nd company name
Full address
(inc postcode)
Tel. No.
Fax No.
Main Contact


Declaration by applicant

I / We formally request you to open a Credit Account and agree to adhere to L Jalley & co Ltd Credit Terms and the Terms and Conditions of Sale (as found on the reverese of Jalley Deleivery Notes & Invoices and on the web site at http://www.jalley.co.uk)

Payment terms are strictly 30 days.

By ticking the following box you agree that you have read, understood and freely agree to this declaration.

I agree


Download this form
Alternatively you can download and print an account application form .pdf format. Simply complete it offline and send it to us by fax or post.

 Click here to download the form.



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