Your Application Progress

Credit Application

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

Before starting your application for a credit account with us, please ensure you have the listed documents below. Without these you will not be able to proceed with your application as these are required for our credit checks.

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

Please refrain from using the "&" ampersand symbol during the application form as this may cause delays in us receiving your application

Once the application has been completed and the required documents uploaded a £1.00 deposit into our bank account is required to help prevent against fraudulent activity. Bank details are provided at the end of the application.

Please Note: The £1.00 credit balance will be added onto your account once the account has been setup for you to deduct in your first payment to us.

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 Line 1: *

Statement Address Line 1: (if different)

Invoice Address Line 2: *

Statement Address Line 2:

Invoice Town: *

Statement Town:

Invoice County: *

Statement County:

Invoice Postcode: *

Statement Postcode:

Accounts Payable Telephone No: *

Fax No:

Accounts Payable Email: *

Contact 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: *

Bankers Address Line 1: *

Bankers Address Line 2: *

Bankers Town: *

Bankers County:*

Bankers Postcode: *

Bank Account Number:*

Sort Code: *

Nature of Business:*

How long established? *

Total Credit Limit Required:* £

Invoice Currency: * GBP Euro

Upload your company letterhead document (jpg, png, pdf, docx, tif) 5Mb Max: * 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)

Limited Company Address Line 1: (if different from above)

Limited Company Address Line 2:

Limited Company Town:

Limited Company County:

Limited Company Postcode:

Company Registration No: *

Incorporation Date: *

- Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Month - January Febuary March April May June July August September October November December - Year - 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947

VAT Reg No:*

Name of Ultimate Holding Company (if applicable)

Name of Director 1: *

Name of Director 2:

Name of Director 3:

Name of Director 4:

Upload your VAT Certificate (jpg, png, pdf, docx, tif) 5Mb Max: * Browse

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

Please provide two trade references who we may contact for further information regarding your credit application.

Company Name of Reference 1: *

Company Name of Reference 2: *

Name: *

Name: *

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 confirm the particulars stated above are correct and I am authorised to act on behalf of the company applying for credit facilities.

Print Name:*

Title/Status:*

On behalf of (Business Name) : *

Date: *

- Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Month - January Febuary March April May June July August September October November December - Year - 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947

Bank	Wells Fargo Bank NA
Account Name	Rom Limited
Sort Code CHAPS	16-56-71
Sort Code BACS	40-51-33
Account	88006303

GBP Payments
Bank	Wells Fargo Bank NA
Account Name	Romtech Limited
Sort Code CHAPS	16-56-71
Sort Code BACS	40-51-33
Account	88006305

Euro Payments
Bank	Wells Fargo Bank NA
Account Name	Romtech Limited
IBAN	GB83PNBP16567188006306
SWIFT BIC	PNBPGB2L
Account	88006306

I confirm that I have paid the £1 deposit *

** IMPORTANT DATA PROTECTION **

We will use the information collected on this form to register your account, for our internal record keeping to assess your credit worthiness, which may involve passing the information to credit reference agencies, and receiving information from them about you. If we do use the information to make a search with a credit reference agency, that agency will keep a record of that search and will share that information with other businesses. We may also make enquiries about the principal directors with the credit reference agency. We will monitor and record information relating to your trade performance and such records will be made available to credit reference agencies, who will share that information with other businesses in assessing applications for credit and fraud prevention.

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

Company Name (if different from Section A)

Proprietor 1

Proprietor 2

Full Name(s) of Proprietor 1*

Full Name(s) of Proprietor 2

Address Line 1 (if different from Section A)

Address Line 2 (if different from Section A)

Town (if different from Section A)

County (if different from Section A)

Postcode (if different from Section A)

VAT Reg No: *

Upload your VAT Certificate (jpg, png, pdf, docx, tif) 5Mb Max: * Browse

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

Please provide two trade references who we may contact for further information regarding your credit application.

Company Name of Reference 1: *

Company Name of Reference 2: *

Name: *

Name: *

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 confirm the particulars stated above are correct and I am authorised to act on behalf of the company applying for credit facilities.

Print Name: *

Title/Status: *

On behalf of (Business Name) : *

Date: *

- Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Month - January Febuary March April May June July August September October November December - Year - 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947

Bank	Wells Fargo Bank NA
Account Name	Rom Limited
Sort Code CHAPS	16-56-71
Sort Code BACS	40-51-33
Account	88006303

GBP Payments
Bank	Wells Fargo Bank NA
Account Name	Romtech Limited
Sort Code CHAPS	16-56-71
Sort Code BACS	40-51-33
Account	88006305

Euro Payments
Bank	Wells Fargo Bank NA
Account Name	Romtech Limited
IBAN	GB83PNBP16567188006306
SWIFT BIC	PNBPGB2L
Account	88006306

I confirm that I have paid the £1 deposit *

** IMPORTANT DATA PROTECTION **

We will use the information collected on this form to register your account, for our internal record keeping to assess your credit worthiness, which may involve passing the information to credit reference agencies, and receiving information from them about you. If we do use the information to make a search with a credit reference agency, that agency will keep a record of that search and will share that information with other businesses. We may also make enquiries about the principal directors with the credit reference agency. We will monitor and record information relating to your trade performance and such records will be made available to credit reference agencies, who will share that information with other businesses in assessing applications for credit and fraud prevention.

Submit Application