New Customer Form

Company Name *

Company Registration No. (if applicable)

Phone Number *

Current number of employees

Purchasing

Now we need to collect information about your purchasing contacts.

Note:

This form allows for up to five purchasing contacts, if you need more, please complete the first five and contact us with the additional addresses.

How many Purchasing Contacts would you like?

Purchasing Contact 1 First Name

First Name

Purchasing Contact 1 Last Name

Last Name

Purchasing Contact 1 Phone Number

Phone Number

Purchasing Contact 1 Email Address

Email Address

Purchasing Contact 2 First Name

First Name

Purchasing Contact 2 Last Name

Last Name

Purchasing Contact 2 Phone Number

Phone Number

Purchasing Contact 2 Email Address

Email Address

Purchasing Contact 3 First Name

First Name

Purchasing Contact 3 Last Name

Last Name

Purchasing Contact 3 Phone Number

Phone Number

Purchasing Contact 3 Email Address

Email Address

Purchasing Contact 4 First Name

First Name

Purchasing Contact 4 Last Name

Last Name

Purchasing Contact 4 Phone Number

Phone Number

Purchasing Contact 4 Email Address

Email Address

Purchasing Contact 5 First Name

First Name

Purchasing Contact 5 Last Name

Last Name

Purchasing Contact 5 Phone Number

Phone Number

Purchasing Contact 5 Email Address

Email Address

Delivery

Now let's gather some delivery information from you.

Note:

This form allows for up to ten delivery addresses, if you need more, please complete the first ten and contact us with the additional addresses.

How many delivery addresses would you like to set up?

Delivery Contact 1 First Name

First Name

Delivery Contact 1 Last Name

Last Name

Delivery Address 1

City

State/Province

Zip/Postal

Country

Delivery Contact 2 First Name

First Name

Delivery Contact 2 Last Name

Last Name

Delivery Address 2

City

State/Province

Zip/Postal

Country

Delivery Contact 3 First Name

First Name

Delivery Contact 3 Last Name

Last Name

Delivery Address 3

City

State/Province

Zip/Postal

Country

Delivery Contact 4 First Name

First Name

Delivery Contact 4 Last Name

Last Name

Delivery Address 4

City

State/Province

Zip/Postal

Country

Delivery Contact 5 First Name

First Name

Delivery Contact 5 Last Name

Last Name

Delivery Address 5

City

State/Province

Zip/Postal

Country

Delivery Contact 6 First Name

First Name

Delivery Contact 6 Last Name

Last Name

Delivery Address 6

City

State/Province

Zip/Postal

Country

Delivery Contact 7 First Name

First Name

Delivery Contact 7 Last Name

Last Name

Delivery Address 7

City

State/Province

Zip/Postal

Country

Delivery Contact 8 First Name

First Name

Delivery Contact 8 Last Name

Last Name

Delivery Address 8

City

State/Province

Zip/Postal

Country

Delivery Contact 9 First Name

First Name

Delivery Contact 9 Last Name

Last Name

Delivery Address 9

City

State/Province

Zip/Postal

Country

Delivery Contact 10 First Name

First Name

Delivery Contact 10 Last Name

Last Name

Delivery Address 10

City

State/Province

Zip/Postal

Country

Special Delivery Instructions?

Accounts First Name

First Name

Accounts Last Name

Last Name

Accounts Phone Number

Accounts Email Address

How much credit do you think you will need?

Bank Account Information

Please enter the following information about your bank account so that we can cross reference your bank payments with your account

Account Name *

Sort Code

Account Number

Our standard trading terms are 30 days EOM, please tick if you agree

I agree to use your standard 30 days terms

I would like to request our own payment terms

And finally, your name, so we know who to contact if we have any questions.

Your First Name

First Name

Your Last Name

Last Name

Checkboxes

Please click here to confirm that you wish to open a credit account with Contego and that you agree to Contego's terms and conditions of trading