Your Application Progress

Credit Application

Thank you for your interest in applying for Credit Facilities with ROM Ltd.

Before completing the new account application form please can you ensure that you have the below information as without this you will not be able to proceed:

1. Your Company Letter Head
2. Two Trade Reference contact details, including contact number and e-mail address
3. A copy of your VAT Certificate

Once the application has been completed in full and the necessary documents uploaded a £1 deposit into our bank account is required to prevent fraudulent activity. Bank details are provided at the end of the application.

Please Note: The £1 credit balance will be on your account once the account has been setup

Please see below regarding application form.

Everything marked as * is a mandatory question

We would recommend opening the application in Google Chrome

Section A - (To be completed by all applicants)

Full trading title: *

Invoice Address: *

Statement Address:* (if different)

County & Postcode of Invoice Address: *

County & Postcode of Statement Address:*

Accounts Payable Telephone No: *

Fax No:

Accounts Payable Email: *

Name: *

Would you like to receive your Invoices & Statements via PDF: *

Statements: Yes No

Invoices: Yes No

Email Address For Statement: *

Email Address For Invoices: *

Bankers Name & Address:

A/C No:*

Sort Code: *

Nature of Business:*

How long established? *

Total Credit Limit Required:* £

Invoice Currency: *

Upload your company letterhead document: * Browse

Are you a limited company? *

Yes No

Section B - Company Details (To be completed by Limited Companies only)

Company Name (if different from above)* Incorporation Date: *

Registered Office Address: (if different from above)*

Company Registration No: *

Issued & Paid Up Capital * £

VAT Reg No: * Name of ultimate Holding Company(if applicable)

Name of Directors: *

Upload your VAT Certificate* Browse

Section C - References (To be completed by all applicants)

Full names and addresses of two trade references to whom an approach may be made. Please give two with whom you have established credit accounts that can speak for comparable figures as requested in Section A.

Reference Name 1: *

Reference Name 2: *

E-Mail Address Of Reference Name 1: *

E-Mail Address Of Reference Name 2: *

Telephone No Of Reference Name 1 : *

Telephone No Of Reference Name 2 : *

Upload your Reference Details : Browse

I/We hereby apply for a credit account and agree to pay accounts by the last day of each month following month of collection or delivery.

I/We hereby agree to operate my/our account in accordance with the conditions of sale overleaf.

I/We confirm the particulars stated above are correct.

I/We authorise ROM Ltd to make status enquiries on connection with this application for credit facilities.

Signed:

Print Name:*

Title/Status:*

On behalf of: *

Date: *

Section B - Company Details (To be completed by Sole Traders, Partnerships etc.)

Full Name(s) of Proprietor(s) / All Partners*

Address (if different from Section A)*

Telephone Numbers *

VAT Reg No: *

Upload your VAT Certificate* Browse

Section C - References (To be completed by all applicants)

Full names and addresses of two trade references to whom an approach may be made. Please give two with whom you have established credit accounts that can speak for comparable figures as requested in Section A.

Reference Name 1: *

Reference Name 2: *

E-Mail Address Of Reference Name 1: *

E-Mail Address Of Reference Name 2: *

Telephone No Of Reference Name 1 : *

Telephone No Of Reference Name 2 : *

I/We hereby apply for a credit account and agree to pay accounts by the last day of each month following month of collection or delivery.

I/We hereby agree to operate my/our account in accordance with the conditions of sale overleaf.

I/We confirm the particulars stated above are correct.

I/We authorise ROM Ltd to make status enquiries on connection with this application for credit facilities.

Signed:

Print Name: *

Title/Status: *

On behalf of: *

Date: *

Submit Application