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To apply to Dorset Nursing Supplies for a Credit Account please complete the form below and press the 'Apply' button at the bottom of the form.

 Application for a Credit Account

Please fill out all areas (Hint: Use the Tab key to move from field to field)

Your Name

Trading Name

Your Position

Business Address

Business Telephone no.

Business FAX number

Email address

Limited Company Reference Number
Please provide the names and addresses of Director(s) / Partners / Proprietor

Name 1

Address

Name 2

Address

Name 3

Address

Name 4

Address
Please provide information about your Bankers and your bank account details.

Bank Name

Branch Address

Branch Sort Code
format 99-99-99

Your Account Number
Please provide the name, address and telephone number of two independent traders that Dorset Nursing Supplies may contact for references.

Name 1

Address

Telephone no.

Name 2

Address

Telephone no.

Tick the box if you would like us to send you a copy of your Application.
I/We apply for credit facilities and understand that settlement is required within thirty days of date of invoice and that interest will be charged on overdue accounts.

I/We acknowledge and accept all other terms and conditions as published in the supplier's catalogues and other media.
   
 

3 Wickham Road, Boscombe, Bournemouth BH7 6JX.   Tel: 0845 1300 220 / 01202 425070 Fax: (01202) 418332
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© 2000-2008 Dorset Nursing Supplies (DNS) and Atonic Ltd.