Credit Account Application Form

Send to:
Big O Taxis, 21 Upper Dominick Street; Galway. Ireland

Trading Name ..................................... No. Years in Business ........................................
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 Type .......................................

Trade Reference (1) ............................................ Card Name .......................................
Telephone No. ............................................ Card Number .......................................
Trade Reference (2) ........................................... Expiry Date ........................................
Telephone No. ..........................................

I/We Authorise references to be taken from the above named Companies in support of our application for credit facilities
Signed .................................
Date .................................
Position ................................