ACCOUNT APPLICATION FORM

PLEASE RETURN THIS FORM TO:

_____________________FAX NO:__________________________

1. CUSTOMER DETAILS
CUSTOMER NAME : _____________________________________________________ACCOUNT NO:
(This must be your full legally registered name)
LIMITED

PLC

SOLE TRADER

PARTNERSHIP (incl LLP)

ADDRESS :_______________________________________________TOWN :

PRIVATE INDIVIDUAL

_____________________________________

COUNTY :_________________________________POSTCODE :______________ COUNTRY :
CONTACT NAME :

_________________________________________ JOB TITLE

:

_______________________

__________________________________

E-MAIL ADDRESS :________________________________________ NATURE OF BUSINESS :
TELEPHONE NO :

_______________________

_________________________________________ FAX NO

:

____________________________________

______________________________________ VAT NO

:

____________________________________

COMPANY REG. NO :

DO YOU ALREADY HAVE AN

ACCOUNT WITH DHL?

YES

NO

IF YES, PLEASE STATE YOUR ACCOUNT

NUMBER(S):

____________________________________________________________________________________________________
2. SOLE TRADER/PRINCIPAL PARTNERS INFORMATION – (Please only complete this section
if you are a Sole Trader / Partnership)
SOLE TRADER/PRINCIPAL PARTNERS SURNAME : ___________________ FORENAME(S) : ________________________
TITLE :

_____________HOME ADDRESS

:

__________________________________________________________________

TOWN :__________________________________________________COUNTY :____________________________________
POSTCODE :

_____________________________________________COUNTRY :___________________________________

PRINCIPAL PARTNERS SURNAME :
TITLE :

________________________________ FORENAME(S)

_____________HOME ADDRESS

:

:

________________________

__________________________________________________________________

TOWN :__________________________________________________COUNTY :____________________________________
POSTCODE :

_____________________________________________COUNTRY :___________________________________

3. YOUR INVOICING DETAILS (Please only complete if different from section 1)
INVOICING ADDRESS :_________________________________BUILDING NAME :_________________________________
TOWN :______________________________________________COUNTY :________________________________________
POSTCODE :

_________________________________________COUNTRY :_______________________________________

CONTACT : (TITLE)
JOB TITLE :

_________ FORENAME(S)

:

__________________________ SURNAME

______________________________________

TELEPHONE NO :

:

______________________

____________________________________

4 . YOUR COLLECTION ADDRESS (Please only complete if different from section 2, if there
is more than 1 collection address please complete page 3)
COLLECTION ADDRESS : __________________________________BUILDING NAME :_____________________________
TOWN :__________________________________________________COUNTY :____________________________________
POSTCODE :

_____________________________________________COUNTRY :___________________________________

CONTACT: (TITLE)

___________ FORENAME(S)

:

__________________________ SURNAME

______________________________________
Expires:31/08/2007

JOB TITLE :

Version 3.4

TELEPHONE NO :

:

______________________

____________________________________
Account Application Form ~

ACCOUNT APPLICATION FORM

6. SECURITY STATUS
Will items not belonging to you be sent on this DHL account(s)? YES

NO

Are you a listed agent with the DfT (Department for Transport?
YES
NO
If YES, please state your DfT listing number: _____________________________________________________________

For DHL use – Security Flag to be applied (to be completed by DHL) UNK

DfT

L/O

UNK=(UNKNOWN CARGO), DFT=(DEPARTMENT FOR TRANSPORT), L/O=(LEAVE OPEN)

7. CUSTOMS INFORMATION FOR IMPORTATION INTO THE UK
Do you have a deferment account? YES

NO

Please supply your deferment account number:

___________________________________________________________

8. AUTHORISATION
1.

DHL Express (“DHL”) agrees to provide you the customer (“You”) with transportation services (“Services”)
in reliance of the information given by You on this application form and Your signature below is Your
acknowledgement that the information provided is accurate.

2.

The Services are provided in accordance with DHL’s standard terms and conditions of Carriage as varied
from time to time (“Terms”) a copy of which are set out on our website (www.dhl.co.uk) and a paper copy
can be provided to you on request. By signing below You confirm that You have read and understood the
Terms and agree to be bound by the Terms. This application form, DHL’s current tariff schedule, the Terms
and any other schedules provided to You by DHL relating to the Services constitute the agreement between
You and DHL and any variations to this agreement will only be effective if agreed in writing by authorised
DHL personnel.

3.

DHL may make searches about You (and/or, where applicable, Your principal Partners) with credit reference
agencies who will supply DHL with credit information as well as information from the Electoral Register so
as to allow DHL to verify Your (and/or Your principal Partners) identity and credit record. These agencies
will record details of the search whether or not this application proceeds. You (and/or Your principal
Partners) hereby consent to such searches being made and any information being obtained from these
searches being used by DHL and any of its associated or affiliated companies.

4.

DHL will use any personal information it collects about You in order to carry out the Services quickly and
efficiently and in order to bill You and contact You when necessary in relation to the Services. DHL will not
share this information with anyone other than companies associated or affiliated with DHL. All information
is stored securely and in accordance with the Data Protection Act 1998.

5.

DHL may also from time to time send You details of special offers, discounts and updates to DHL’s services
which may interest You. If You do not wish to receive such information please tick the following box.
Any comments, queries, or questions relating to DHL’s use of Your information should be addressed to:Customer Services Manager, Millenium House, East Midlands, Unit 5, Argosy Road, Castle Donnington,
Derbyshire, DF7 ZSA

Signed on behalf of the customer
PRINT NAME:

_________________________ SIGNATURE: ________________________ DATE: _______________________

FOR DHL USE ONLY
PLEASE TICK SERVICE REQUIRED
SAMEDAY

NEXTDA
Y

EUROPEAN
ROAD

SELEC
T

AIR EXPRESS

UK Connect

AIR EXPRESS EXPORT

IMPORT

ACCOUNT MANAGER

TERRITORY CODE

SERVICE CENTRE

COMET GSFA ID

MAJOR ACC CODE

KEY ACCOUNT CODE

INDUSTRY CODE

ROUTE CODE

AMEND (TICK IF YES)

DUN & BRADSTREET
NUMBER

SIC CODE

UPGRADE

Expires:31/08/2007
Version 3.4

Account Application Form ~

ACCOUNT APPLICATION FORM

APPLICATION FOR ACCOUNT FACILITES SIGNED AND FILED AT STATION ?

FOR ADDITIONAL COLLECTION ADDRESSES:
COLLECTION ADDRESS 2
COLLECTION ADDRESS: ____________________________________BUILDING NAME:_________________________
TOWN:___________________________________________________COUNTY:________________________________
POSTCODE:

______________________________________________COUNTRY:_______________________________

CONTACT: (TITLE)

___________ FORENAME(S): ___________________________ SURNAME: __________________

_______________________________________ TELEPHONE NO: ________________________________
COLLECTION ADDRESS 3
COLLECTION ADDRESS: ____________________________________BUILDING NAME:_________________________
JOB TITLE:

TOWN:___________________________________________________COUNTY:________________________________
POSTCODE:

______________________________________________COUNTRY:_______________________________

CONTACT: (TITLE)

___________ FORENAME(S): ___________________________ SURNAME: __________________

_______________________________________ TELEPHONE NO: ________________________________
COLLECTION ADDRESS 4
COLLECTION ADDRESS: ____________________________________BUILDING NAME:_________________________
JOB TITLE:

TOWN:___________________________________________________COUNTY:________________________________
POSTCODE:

______________________________________________COUNTRY:_______________________________

CONTACT: (TITLE)
JOB TITLE:

___________ FORENAME(S): ___________________________ SURNAME: __________________

_______________________________________

Expires:31/08/2007
Version 3.4

TELEPHONE NO:

________________________________

Account Application Form ~