Welding Equipment by WIRS (Wolverhampton) Ltd Credit Application Form

Application for Credit Facilities

Please enter Your Company details below:

Name: *
Company: *
Company Reg No: *
Address: *
Telephone: *
Fax:
Email: *
Please enter your 1st Trade Reference:
Contact Name: *
Company: *
Address: *
Telephone: *
Fax:
Please enter your 2nd Trade Reference:
Contact Name: *
Company: *
Address: *
Telephone: *
Fax:
Please enter your Bankers contact details:
Bank Name: *
Branch Address: *
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Account Number: *
	I hereby declare this information to be correct.

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