NEW CUSTOMER REGISTRATION FORM

					                                             JS ENTERPRISES LIMITED
                                             PO Box 1054, Canterbury, Kent, CT1 9HP
                                             Tel: 01865 400 444 Fax: 01233 740 044


                                     NEW CUSTOMER CREDIT CARD ACCOUNT FORM

   Company Name                                                          Trading Name
                                                                         (If applicable)

   Invoice Address (Including Postcode)                                  Delivery Address (Including Postcode)


   Postcode:
   Tel No:                                                               Postcode:
   Fax No:                                                               Tel No:
   Email:                                                                Fax No:
   Web:

   VAT Registration No:                                                  Partnership / Sole Trader
                                                                         Proprietor 1:
   Registration No:                                                      Private Address:
   Director 1:
   Director 2:
   Director 3:                                                           Proprietor 2:
                                                                         Private Address:
   Credit Card Details
   Name on Card:
   Card No:
   Start Date:                                                           General Information
   Expiry Date:                                                          Date Trading Commenced:
   Issue No:
   Security No: (For security reasons, please call with last 3 digits)   Person Responsible For Accounts:
   Address: (Where credit card statements are sent)
                                                                         Person Responsible For Purchasing:

   Postcode:                                                             Type Of Company:
                                                                         Retail/Wholesale/Market Trader/Web Based
                                                                         Other (please list)

        I hereby confirm that JS Enterprises Limited are authorised to collect payment from the above
                                               Credit/debit card
.
Proprietor’s/Director’s signature: .................................................................Date: ........................

Sage:
Citylink:
D/Base:
File:
Customer Advised:
Analysis 1 2 3


                                              Fax Back: 01233 740 044

                                        www.accessorystock.co.uk

				
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