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CLIENT APPLICATION FORM

Finance Details

New Account Number (Office use only)
FULL REGISTERED ADDRESS
ADDRESS
CUSTOMER DETAILS
NAME
TELEPHONE NO.
POSITION
FAX NO.
E-MAIL
METHODS OF PAYMENT
DIRECT DEBIT *
/
BACS **
/
CHEQUE
/
CREDIT CARD
/
SIGNATURE
DATE
Account Name (Office use only)
ACCOUNTS DEPARTMENT CONTACT DETAILS
NAME
TELEPHONE NO.
FAX NO.
E-MAIL
TICK FOR ONLINE BOOKING & REPORTING
HAVE YOU PREVIOUSLY HAD AN ACCOUNT WITH US?
/
Do you have any other accounts with London Access Cars?
/
If YES, what is your account number?
Is a reference required with each booking?
/
If YES, please list? E.g. security code, purchase order number etc
I accept that your terms are 30 days net and hereby apply for a credit account. I accept your terms and conditions of trading are as published by the RHA (Road Haulage Association) and that the tariffs supplied to me have been calculated by the Access Cars computer grid and are zoned. The mileages between these zones may at times differ from those published by some Automobile organizations. I agree to abide by them in full. I confirm that I am authorized to make this application.
* Information will be e-mailed on account activation
** Our Bank Details are available upon request
Please call back to 0208 467 0 467 / 0208 295 0 295