New Customer Account Form

City Rewinds & Drives Ltd, Unit K2 Troon Way Business Centre, Humberstone Lane, Leicester LE4 9HA

All fields marked with an * must be completed

Name*
Job Title
Company Name*
Address*
Postcode*
Telephone*
Fax
E-mail*
VAT No
Date Opened*
Monthly credit required*
Service supplied

Terms 30 days nett


BANK DETAILS

Name of Bank*
Address*
Sort Code*
Account No.*
Acount Name*

TRADE REFERENCES

Reference 1

Name*
Address*

Reference 2

Name*
Address*



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