Credit Application For A1 Chemical Waste Management Ltd

Credit Application

Please fill out the form below to submit your Online Credit Application to A1 Chemical Waste Management Ltd.

If you prefer to fill out a paper version of this form, please go to our Permits and Policies page to download one.

Please make sure you fill in ALL sections of this form

COMPANY DETAILS
Company Name*
Accounts Dept. contact name*
Invoice address:*
Postcode*
Phone*
Fax
Invoice Email*
(For environmental purposes A1 Chemical Waste Management Limited prefer to send invoices by email)
Co. registration no:
How long have you been trading:*
SIC (Standard Industry Classification) No.
Bank Name:*
Account No.*
Sort Code*
Bank Address*
Postcode:*
TRADE REFERENCES
Firm name:*
Phone*
Fax
Contact*
Address:*
Firm name:*
Phone*
Fax
Contact*
Address:*
The undersigned herby agrees that should a credit account be opened and in the event of default in the payment of any amount due, and if such account is submitted to a collection authority, to pay an additional charge equal to the cost of collection including court costs. The undersigned also agrees to the applicable A1 Chemical Waste Management Limited Terms and Conditions and payment terms which is 30 days after the date of invoice, i.e. 30 days nett of invoice date unless otherwise agreed in writing.
Name*
Position within Company*
Who is your A1 Contact?*
Phone
This field is for validation purposes and should be left unchanged.

Credit Application