SIGN UP FOR AN ACCOUNT

Company Details

Company Name:

Trading Name: (if different)

Year Commenced Trading:

Invoice Address:

Postcode:

Telephone Number:

Fax Number:

Company E-mail Address:

Registered Office

Company Registration No: (Corporate Companies only)

Registered Office Address:

Postcode:

Statement Address

Statement Address: (if different)

Postcode:

Fax Number:

Telephone Number:

Delivery Address

Delivery Address: (if different)

Postcode:

Fax Number:

Telephone Number:

If you have multiple delivery addresses, please include these on a separate list and attach to this application)

Sole Traders or Partnerships only

(Please give the full names and private addresses of all individuals)

Title: MrMrsMissMsOther

Forename(s):

Surname:

Date of Birth:

Full Address:

Postcode:

How long at this address:

Title: MrMrsMissMsOther

Forename(s):

Surname:

Date of Birth:

Full Address:

Postcode:

How long at this address:

Key Contacts

(Please list key personnel within your organisation with whom we would have a day to day contact)

Person Responsible for the Purchasing of Parts:

Title: MrMrsMissMsOther

Forename(s):

Surname:

Date of Birth:

Telephone Number:

Fax Number:

E-mail Address:

Person Responsible for the Payment of our Accounts:

Title: MrMrsMissMsOther

Forename(s):

Surname:

Date of Birth:

Telephone Number:

Fax Number:

E-mail Address:

Please tell us a little bit about your business:

Please indicate your type of business:

Type of Business: Fleet OperatorOwner DriverBus/Coach OperatorRepairerLease/Hire CompanyExporterFranchised DealerEngine ReconditionerMotor FactorBody Shop

Do you issue official order numbers: YesNo

Where did you hear about us?

Please state the exact quantity & model types of the vehicles you currently own / operate / repair (if applicable):

Total No. of Iveco:

Total No. of MAN:

Total No. of Mercedes:

Total No. of Renault:

Total No. of Scania:

Total No. of Daf:

Total No. of Volvo:

Total No. of Other:

Additional Information:

Verification

We wish to apply for credit facilities with your company and we have read your standard terms and conditions of trade. We accept your conditions of trade including your payment terms, which are strictly nett 30 days.

Signature:Print:Job Title:Dated:

Signature:Print:Job Title:Dated:

This application must be signed by a person duly authorised to do so, and in the case of corporate companies this must be a DIRECTOR, COMPANY SECRETARY or other person duly authorised by the company. The capacity of the signatory must be stated, i.e. DIRECTOR, COMPANY SECRETARY, MANAGER, OWNER or PARTNER, etc. In the case of partnerships ALL PARTNERS MUST SIGN.

We are a Data Controller under the Date Protection Act 1998 ("the Act") and comply with the data protection principles set out in the Act in relation to handling any personal data which you may provide to us to the extent that the Act requires. To update your marketing preferences, please visit www.imexpart.com/consent or to unsubscribe email your company name and postcode to datacontroller@imexpart.com. Our privacy policy can be viewed on our website. By signing this application you acknowledge and consent that we may provide access to and transfer data to financiers/credit reference agencies for the purpose of provision of their services to us in respect of credit reference searches, credit control and analysis (including credit scoring, market, product and statistical analysis), provision of security and protection of our commercial interests. Any financiers/credit controllers to whom disclosure is made will keep and transfer the data only for the purposes stated. Details of our financiers and any credit reference agencies used will be made available upon request.

STEP 1 - PRINT STEP 2 - SUBMIT INFORMATION

Print this Form