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1. Please ensure that this form is completed in BLOCK CAPITALS so as to avoid unnecessary delays in processing.

2. PLEASE SUPPLY A COPY OF YOUR OFFICIAL NOTEPAPER.

3. Please allow up to 21 days for the application to be processed.

4. PLEASE COMPLETE SECTIONS OVERLEAF.

FULL TRADING NAME

FULL NAME OF APPLICANT Phone Numbers : Main

Full Delivery Address (if different from the above)

I / We wish to apply for a Credit Account, for which purpose the following three references are tendered Bankers Sort Code

TRADE REFERENCE (1) Name Address

TRADE REFERENCE (2) Name Address

Phone Numbers: Main Fax

AVERAGE MONTHLY CREDIT REQUIRED £

I/ We understand all your accounts are strictly nett and that settlement is due by the 15th day of the month following the date of invoice Signed

In order for us to be able to monitor our marketing and to ensure that we provide the best possible service, would you please be kind enough to answer the following questions in order to help us with this process.

If your business is non farming, please state business type?

Could you please give additional information on farm implements used i.e. for plough type, if you have a Dowdeswell plough and a Kverneland plough, please write Dowdeswell x 1 and Kverneland x 1. If you know that the Dowdeswell is a DD and the Kverneland is a Number 8 body, please add this also.

Additional Information which you feel may be helpful

THANK YOU VERY MUCH FOR YOUR HELP. WE LOOK FORWARD TO SERVICING YOUR NEEDS