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Dealer & Account application

Please complete the application form below and after checking we will email you your authorisation. Please note that this application form is for bona fide business only. An authorisation and account facility will only be issued after careful vetting. As a verified/bonafide dealer you will also be able to order online.

Your Details
Name: Required
Contact Phone: Required
Contact Email*: Required
Job title:
Company Details
Company Name: Required
Please describe your company's Activity:
Other (please specify):
Company address: Required
 
 
Postcode:
Company registration number Required
Phone number: Required
Fax number: Required
Web site: Required
Trade Reference
Company Name: Required
Address: Required
  Required
Post code: Required
Contact name: Required
Contact phone: Required
User name and password
Enter your username: Required
Enter password: (Min 6 digits) Required
Retype password to confirm: Required


*Please note: For Vetting purposes "free email" accounts from Google, Hotmail or Yahoo are not acceptable and if you are unable to provide an alternative, please answer these questions on your company letter-headed paper and fax to: +44 118 943 3366, thank you.

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