Online Credit Application Thank you for choosing Country Fresh Foods to supply your fresh foods and deli requirements. Please complete our online contract form or download the form to complete and send to us.

COMPANY DETAILS

Company Name*

Company Address*

Company Tel No*

Company Fax No*

Company Email*

TRADING NAME (if different from reg.)

Trading Name*

Delivery/Invoice Address*

Delivery/Invoice Tel No*

Delivery/Invoice Fax No*

Delivery/Invoice Email*

Date Commenced Trading* (format dd/mm/yyyy)

Company Registration Number*

Trading Style*
LimitedPartnershipSole Proprietor

PROPRIETOR DETAILS

Proprietor Full Name*

Proprietor Tel No*

Proprietor Date of Birth* (format dd/mm/yyyy)

Proprietor Address*

ACCOUNT DETAILS

Please confirm how you would prefer to order from us*
PhoneEmailFax

Please confirm how you are going to make payment*
BACSCashCheque

Credit Limit Required*
£

Credit Terms Required*

CONTACT DETAILS

Please select as appropriate
Principle Buyer or PurchasingCateringStoresGeneral Manager

Full Name

Mobile

Landline

Email

FINANCE MANAGER

Full Name*

Mobile*

Landline*

Email*

HEAD CHEF

Full Name

Mobile

Landline

Email

TRADE REFERENCES

Please provide the details of 3 companies which you currently regularly trade with on an account basis.

These companies must be based within the UK and have a good knowledge of your account. Please note that we do not accept references from competitors within our trade.

Reference One

Company Name*

Address*

Phone*

Fax*

Email*

Type of Account*

Length of Trade*

Reference Two

Company Name*

Address*

Phone*

Fax*

Email*

Type of Account*

Length of Trade*

Reference Three

Company Name*

Address*

Phone*

Fax*

Email*

Type of Account*

Length of Trade*

CONFIRMATION

We hereby agree to the following - to be signed by the Owner or Director

Applicant Name*

Applicant Position*

Email Address*

By signing this agreement you agree to this Company’s terms and conditions, details of which are available upon request.

Signed* (please use mouse or input device to sign)

Date Signed* (format dd/mm/yyyy)