1. Company Information

Registered Company Name:

Abbreviated Name (if applicable):

Company Registration Number:

VAT Registration Number:

Registered Address:

Main Telephone:

Are you part of a subsidiary?
YesNo

If yes, please provide company name & address below:

Years Trading

Offered Credit Limit:

2. Contact Information

Account Manager:

Telephone:

Email:

3. Accounts Information

Credit Control Contact:

Telephone:

Email:

4. Customer References

Please provide the details of 2 companies we can contact to provide a trade reference.

Company Name 1

Contact Name

Email

Company Name 2:

Contact Name:

Email:

5. Insurance

Please provide details of your current insurance cover.

Employers Liability

Public Liability

6. Quality Assurance

Does your organisation hold a recognised quality management certification for example BS/EN/ISO 9001 or equivalent? YesNo

If not, does your organisation have a quality management system? N/AYesNo

7. Professional and Business Standing

Do any of the following apply to your organisation, or to (any of) the director(s)/partners/proprietor(s)?

Is in a state of bankruptcy, insolvency, compulsory winding up, receivership, composition with creditors, or subject to relevent proceedings.YesNo

Has been convicted of a criminal offence related to business or professional conduct.YesNo

Has committed an act of gross misconduct in the course of business.YesNo

Has not fulfilled obligations related to payment of social security contributions.YesNo

Has not fulfilled obligations related to payment of taxes.YesNo

Is guilty of serious misrepresentation in supplying information.YesNo

Is not in possession of relevant licenses or membership of an appropriate organisation where required by law.YesNo

If the answer to any of these is 'Yes', please give brief details below, including what has been done to rectify the situation.

8. Bank Details

Bank Name:

Bank Address:

Account Name:

Sort Code:

Account No.:

9. Declaration

I declare that to the best of my knowledge the answers submitted in this form and any supporting modules are correct. I understand that the information will be used in the evaluation process to assess my organisation's suitability to supply to BCN Group Ltd.

Signed (Please use your mouse to sign below):

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Date:

Full Name

Position