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Credit Product
*
Application Amount
£
Company Information
*
Business Name
Registered/Business Number
Legal Status
Limited
Non Limited
Government
*
Mailing Address
Mailing Address2
Mailing Address3
Mailing Address4
Mailing Address5
Post Code
*
Telephone - Business
Telephone - Mobile
*
Email Address
*
Delivery Address Line 1
Delivery Address Line 2
Delivery Address Line 3
Delivery Address Line 4
Delivery Address Line 5
*
Delivery Address Postcode
*
Current Brakes Account Numbers
*
Bank Name
Bank Address
Bank Address Postcode
*
Bank Account Number
*
Bank Sort Code
*
Payment Method i.e. Direct Debit, BACS
Name of Buying Group, if applicable.
Director/Proprietor/Business Owner Information
Type
Director
Proprietor
Business Owner
*
First Name
*
Last Name
Flat
House Name
House Number
*
Post Code
Street
District
Town
*
Telephone - Business
Email Address
Date Of Birth
First Name
Last Name
Flat
House Name
House Number
Post Code
Street
District
Town
Telephone - Business
Email Address
Date Of Birth
Collateral
Trade Reference 1 Company Name
Trade Reference 1 Contact Name
Trade Reference 1 Telephone Number
Attachments
Please attach documents relevant to the application decision process (i.e., company financials, relevant license information, etc)
Attachment Description
Attachment Location
Upload
NOTE: You may attach up to 5 attachments with maximum size of 10 megabytes
Terms and Conditions
PRINT AGREEMENT
*
I agree to the terms and conditions specified above
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