Company Name:

Email:

Contact Name:

Type of Business:

Business Address:

Post Code:  

Delivery Address:

Post Code:  

Telephone Number:

Year Company Was Established:

Mobile:

Company Registration Number:

Fax Number:

VAT Registration Number:

1st Contact Name:

2nd Contact Name:

1st Contact Home Telephone:

2nd Contact Home Telephone:

1st Contact Home Address:

Post Code:  

2nd Contact Home Address:

Post Code:  

Please supply 2 trade references, if no trade references are available please supply a bank reference.
(please note - a bank fee may be payable)

Name:

Name:

Address:

Post Code:  

Address:

Post Code:  

Telephone:

Telephone:

Number of Years Trading With The Company:

Number of Years Trading With The Company::

Bank Details (if no trade references are available)

Bank Name:

Bank Telephone:

Bank Address:

Post Code:  

How Did You Hear About Us?
- Select One - Trade Show Trade Magazine Agent/Rep Other

Do You Purchase Similar Products From Other Companies?
- Select One - Yes No

If Other Please State:

If Yes, Where From:

I have read and agreed to Luv-It trading terms and conditions and understand that Luv-It Furniture reserve the right to refuse any application without reason.

Name:

Signature:

Date:

Position:

Date Application Received:

  References Checked:

Application:

  Approved   Denied