Please complete the below to setup your account all fields marked * are mandatory fields
Your Name*
Your Job Title*
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Legal Business Entity * Limited CompanyLimited Liability PartnershipPrivate Limited CompanySole TraderPartnershipCharityTrust
Trading Name
How many years have you been trading? *
VAT Registration Number (if applicable)
Trading Address
Registered Company Name * Trading Name (if applicable) Company Registration Number *
Registered Trust Name * Trust Trading Name (if applicable) Trust Registration Number (if applicable)
Registered Charity Name * Charity Registration Number *
Owner home address
How many years have you been living at this address? * more than 3 yearsless than 3 years
Proprietors date of birth *
Please add your previous home address: *
How many partners are in the partnership?* onetwothreefour
Partner one home address
Partner 1 date of birth *
Please partner one previous home address: *
Partner two home address
Partner two date of birth *
Please partner two previous home address: *
Partner three home address
Partner three date of birth *
Please partner three previous home address: *
Partner four home address
Partner four date of birth *
Please partner four previous home address: *
Company Opening Times
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Open from: 5:006:006:307:007:308:008:309:009:3010:0010:3011:0012:00 until 16:0016:3017:0017:3018:0018:3019:00
Delivery Address
Is the Invoicing Address the same as the Delivery Address? *YesNo
Invoice Address
Preferred invoicing method? * EmailPortal
Accounts emails address - to be used for invoicing purposes*
We'll be in touch to discuss portal details shortly.
Accounts contact Name*
Accounts Telephone number*
Email address to send statements (if different to above)
The person who will be responsible for ordering consumables:- Full Name:* Telephone Number:* Email Address:*
Do you require Purchase Order references on your invoices? YesNo
Are you VAT exempt? YesNo
If 'Yes' please attached the relevant form
How to setup Direct Debit:
1. Download the direct debit mandate form:Direct Debit Mandate
2. Print, sign and date
3a. Scan it/take a photo and email it to your client manager:
or upload the file here:
Does your company utilise an account Portal? YesNo
If yes please can we ask that the details are entered below and that the required login details are sent to [email protected]
[email protected]
Please agree to the following: As the authorised office of this business, I agree to adhere to stated credit terms. I appreciate that adherence to this obligation is the essence of the contract between us As the authorised Officer of this business I approve Liquidline to carry out credit checks as required I agree to Terms & Conditions
