Bigo Taxis 091 58 58 58
Credit Account Application
email address
Trading Name
No. Years in Business
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
other
Address Line 1
Telephone No.
Address Line 2
Fax No.
Town / City
Accounts Contact
County
Accounts Password
Postcode
Monthly Credit Limit Required
Full names of Proprietor or Partners if not a limited Company:
Bank Reference
Name and address to which accounts are to be sent:
Credit Card Details
Card Type
Visa
Master Card
Trade Reference (1)
Card Name
Telephone No.
Card Number
Trade Reference (2)
Expiry Date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
01
02
03
04
05
06
07
08
09
10
11
12
2004
2005
2006
2007
2008
2009
2010
2011
2012
Telephone No.
I/We Authorise references to be taken from the above named Companies in support of our application for credit facilities
Name
Date
Position