Customer Account Form

Company Name:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Company Registration Number:(Required)

VAT Registration Number:(Required)

Number of Vehicles:(Required)

Vehicle Type (Car/Van/HGV):(Required)

Will a fleet list be provided?(Required)

Additional information required for invoicing (if applicable)

Payment terms of STRICTLY 30 DAYS NET.

Accounts Email Address(Required)

Accounts Key Contact Person(Required)

Order/Defect Number Applicable? (Y/N) If answer is (Y) please state order number request process in detail below:(Required)

**Please note: If Order Number is not given after the process has been followed as requested, invoices will be sent for payment without a PO**

Please Select One:(Required)

Vehicle Registration to be used as PO

PO provided upon time of booking

PO Provided after job completion

Additional Notes:

PO Email(Required)

Phone(Required)

PO- Resolution Key Contact Person Details:(Required)

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