Phone: (01) 88 22 040 Freefax: (01) 88 22 044
* Required fields
Organisation Name:*
Head Office Address:*
Phone No:*
Fax No:*
Contact Name:*
Email:*
Accounts Contact:*
Accounts Phone No:*
Accounts Email:*
Number of regional locations:*
Vat exempt Y/N?:* Yes No
Please supply VAT 13B form if YES:
Are Purchase Orders used Y/N?:* Yes No
If YES are they of a particular format?:
Multi-site / Multi-delivery locations Y/N?:* Yes No
IF NOT MULTI-SITE PLEASE COMPLETE BELOW
Please provide contact details for users who are authorised to order online:*
Invoices will be emailed by default. Please provide email address:*
If hardcopy invoice/statement is required please tick:
All invoices will be generated monthly as one invoice per order, however if an alternative set up is required please tick:
Please provide details:
If yes, details are required in excel format if possible (a template will be supplied)
Please enter in the word you see below: