Credit Application Form printable pdf download

REYNOLDS TOPLINE PROVIDERS

Glebe Street, Mohill,

Townparks Centre, Leitrim Road

Main St, Castlerea,

Co. Leitrim.

Ck-on-Shannon, Co. Leitrim

Co. Roscommon.

Tel. 071 9631083

Tel. 071 9622333

Tel: 094-9620033

Fax. 071 9631523

Fax 071 9622335

Fax: 094-9620633

Email: mohill@iolfree.ie

Email: reytop@iolfree.ie

Reg. Office: Mohill Hardware Ltd.

CREDIT APPLICATION FORM

Requested By:

___________________________________________________________________

Please attach proof of ID e.g. Drivers Licence, Business card, Letterhead, etc.

Address:

___________________________________________________________________

Telephone:

Work__________________ Home_____

__________ Mobile: __________________

___

Occupation/Business: __________________________________________________________________

Employer:

___________________________________________________________________

Nature of Business: _______________________________ VAT No: __________________________

Bank & Branch:

_______________________________ A/C No: ___________________________

€ _______________________ Years in business:____________________

Credit Limit Required

Directors (If Ltd Company): ____________________________________________________________

(Both must sign)

____________________________________________________________

Accounts person (Business):_____________________________________________________________

TRADE REFERENCES (~ NOT CASH & CARRY’S)

(1)

_______________________________________ (2)_____________________________________

_______________________________________

_____________________________________

Phone: _________________________________ Phone: ________________________________

GUARANTEE

In consideration of supplying goods and giving credit to the above, I do hereby guarantee to you the payment of all monies, at

any time due to you in respect of goods and I hereby agree to make good any default by the said person/company in the

payment of the amount due for such goods.

I further agree that this guarantee is to be a continuing guarantee and that no variation of the terms or any extension of credit or

time for payment, or other indulgence, which you may think proper to give, shall impair or discharge my liability hereunder. I

reserve the right by one month’s notice in writing to Mohill Hardware Limited trading as Reynolds Topline Providers to

revoke this Guarantee as to all future dealings with you and the above named.

I / WE AGREE TO ACCEPT TERMS OF MOHILL HARDWARE LTD AS FOUND ATTACHED.

SIGNED: __________________________________________ CREDIT TERMS STRICTLY 30 DAYS

______________________________________________________________________________________________________

For office use only:

Limit Assigned €__________________

Branch_____________

Class _____________

Code__________

Approved by

__________________

Date _____________________

Credit Application Form

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