Delta Distributors AE LIMITED

Account Application Form

Dear Customer

Please fill and submit Application form.

In order to use our B2B Platform we need your permission to send automated marketing emails.

Company name*

Company NO*

VAT NO

Registered Office Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Accounts Contact*

First

Last

Accounts Phone:

Accounts Email*

Email for statements*

Email for invoices*

Purchasing Contact*

First

Last

Purchasing Phone:

Purchasing Email (used for Marketing emails & B2B Platform)*

Director 1 Name

First

Last

Director 1 Phone:

Director 1 Email:

Director 1 Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Director 2 Name

First

Last

Director 2 Phone:

Director 2 Email:

Director 2 Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Delivery Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Company Email*

Phone:

Value of initial order

Estimated Annual Order Value

Date Company Established

Trade References 1*

First

Last

Trade Reference 1 Phone :*

Trade References 1 Email*

Trade References 2*

First

Last

Trade Reference 2 Phone:*

Trade References 2 Email*

Optional if more fields required

Agreement*

I Agree to receive Marketing Emails from Delta Distributors AE LIMITED (sales@deltadistributors.co.uk). All Marketing Emails will be sent to Purchasing Contact Email. IMPORTANT! In order to use B2B Platform we need you to agree to receive Emails from it.

I have read and accepted your Terms of Business including EX-works incoterms. I give my consent to use data from Delta Distributors. Full Terms of Business available on our website.

Agreed By*

First

Last

Position*

Type the code shown:

I consent collecting this data and processing it according to Terms of Business of this website.

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Account Application Form