ACCOUNT REQUEST FORM

Please fill out the form below to apply for an account with EXB (UK) Ltd. Please note that by submitting this form you have not automatically received an account. You will receive an email to confirm your acceptance/inform you of failure to pass.

*Denotes a required field

Full Trading Title*:
Address*: Tel No*:
Fax No:
Sales Tel No:
Postcode*: Accounts Tel No:

Business Principal*: Title*:
Sales Contact: Title:
Accounts Contact: Title:
Company Registration No*: VAT Registration No:

Delivery Address* (inc postcode): Invoice Address (inc. postcode):
Check here if Invoice Address same as Delivery Address

Are you part of a group?
Parent Company Name

Bank Name*:
Address* (inc postcode): Account No*:
Sort Code*:
Approved By:
We authorise our banker to provide a reference on us to EXB (UK) Ltd.

Trade Ref 1*: Trade Ref 2:

Terms & Conditions
Email Address (we need this to send you login details)*
I Agree to these Terms & Conditions