APPLICATION FOR A CREDIT ACCOUNT

(Please note that all details on both page 1 & 2 must be completed. RETURN THIS FORM TO
Failure to do so may delay the approval of this application) PARKER MOTOR SERVICES LTD
DATE OF APPLICATION CENTRAL ACCOUNTS OFFICE
714 MELTON ROAD
THURMASTON
BRANCH NAME LEICESTER LE4 8BD

CREDIT LIMIT REQUIRED

BUSINESS DETAILS LIMITED /PLC COMPANY

Registered Number ……………………

Full Business Name ……………………………………………………..
. Year of Registration ……………………

Full Trading Address Address of Registered office

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Post Code …………………
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Nature Of Business …………………………………………………. Telephone ……………………

Fax ……………………
Telephone …………………… Fax ……………………
If you are s subsidiary or part of another group
of companies, please give the name of your
Please complete the section opposite, appropriate to your business Parent/ Holding Company
…………………… ……………………
Contact Name/
Name of person responsible for the payment of this account:- Registered Number ……………………

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Telephone …………………… Fax …………………… NON LIMITED/PLC COMPANY/BUSINESS

Address to where statements are to be sent (if different to above) Number of Proprietors/Partners ……………………

........................................................................... Year business started ……………………

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Full Name of Proprietor/Principle Partner
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BANK DETAILS...........................................................................
National Insurance Number ……………………
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Bank Name ……………………………………………………..
Full Private Address of Proprietor/Principle Partner
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Address .......................................................
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Post Code …………………
. Telephone ……………………
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Post Code …………………
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Sort Code …………………… Account Number ……………………
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Telephone …………………… Fax……………………
TRADE REFERENCES:

1) Name ………………………………………………………………………………………..

Address ………………………………………………………………………………………..

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Contact Name …………………………………………..

2) Name ………………………………………………………………………………………..

Address ………………………………………………………………………………………..

………………………………………………………………………………………..

Contact Name …………………………………………..

Please note that if you pay by credit card you will incur a charge of 2%+vat for the total amount you
are paying. Standard trade terms are all invoices to be paid within 30 days month end.

PLEASE NOTE THAT IF CREDIT FACILITIES ARE GRANTED YOU ARE REQUIRED TO NOTIFY US
(PARKER MOTOR SERVICES LIMITED) IMMEDIATELY OF ANY CHANGES IN THE INFORMATION
SUPPLIED ON PAGE 1. FAILURE TO DO SO MAY RESULT IN CREDIT FACILITIES BEING
WITHDRAWN WITHOUT NOTICE.

PLEASE ATTACH A BUSINESS LETTERHEAD TO THIS APPLICATION

DECLARATION

The details I have provided herein are true and accurate to the best of my knowledge and believe.
I am authorised to make this application on behalf of the business named on page 1.
I agree that if a Credit Account is opened, payments will be made to you on your started credit
terms (which will be separately notified to me or my authorised agent and agreed in writing).
I agree that until a Credit Account is opened with you, payments will be made in cash on receipt of
your invoice.
Signature …………………………………………..

Full Name (Please print) …………………………………………..

Position …………………………………………..
Date …………………………………………..
I consent to our bankers (as named on page 1) providing a reference on me/us/the Company to
Parker Motor Services Limited.

Signature …………………………………………..
(you must be an authorised signatory as per bank mandate)

Full Name (Please print) …………………………………………..

Date …………………………………………..