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Appliances
Balances
Biology
Chemicals
Chemistry
Clearance
Data Logging
Forensic Science
Glassware, Plastics and Ceramics
Highlights
Lab Equipment
Lab-in-a-Box
Measuring Instruments
Microscopes
Physics
Spares and Accessories
Stationery
Transition from Primary
Unilab
Customer Details
Customer Contact Name
Company/Establishment Name
Company Registration Number
Delivery Address
Postcode
Borough or County
Telephone
Ext.
Fax
E-Mail
Position
Maximum Credit Required
Are there any times when you can't receive delivery from us?
Yes
No
If "yes" please give details
Is your establishment part of a larger group?
Yes
No
If "yes" please give details
Name
Head Office Address
Postcode
Telephone
Ext.
Fax
E-Mail
Payment Office Details
Invoice address (if different from the delivery address)
Contact Name
Position
Address
Postcode
Telephone
Ext
Fax
Invoice to be sent to
Delivery Office
Payment Office
Organisation Type
LEA Controlled
LEA Name
LEA Number
Foundation Service
Voluntary Aided
Locally Managed
Privately Owned
Sole/Trader Partnership - Please give details below
Other - please give details
Sole Trader/Partnership Details
Partner 1:
Home Address
Postcode
Partner 2
Home Address
Postcode
Premises Type
Please select one item only
Primary, Infant, Junior School
Secondary School
School - 5 - 18 Years
Kindergarten or Pre-school
Playgroup or Early Years
Nursery
Special School
Residential School
Further Education
Higher Education
Group or Club
Teachers Centre
Parent Teachers Association
Social Services
Council
Admin Centre - Office, Headquarters
Other - Please give details
Declaration
I/We have completed this application form knowing that the particulars are correct to the best of our knowledge and belief. I/We have read and understand the
terms and conditions
of sale and agree to all the terms as detailed.
By signing this application, you give us your consent to pass your details to a licensed credit reference agency and that we may make periodic checks from time to time within the course of business to manage your account with us.
For a Sole Trader/Partnership the credit reference agency will register a search against your home address. All business partners must sign this form.
Name
Name
Position
Position
Date
Date
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