Account Application

To apply for a Credit Account with Philpotts Limited please complete the form below.

Invoice Details

The following field is

required

Company Name

The following field is

required

Address

The following field is

required

Town / City

The following field is

required

Postcode

The following field is

required

Phone

Fax

The following field is

required

Company Reg No

The following field is

required

Year Established

Accounts Payable Details

The following field is

required

Contact

The following field is

required

The following field is

required

Phone

Delivery Details

The following field is

required

Delivery Contact

The following field is

required

Delivery Address

The following field is

required

Delivery Town / City

The following field is

required

Delivery Postcode

The following field is

required

Delivery Phone

Delivery Fax

The following field is

required

Delivery Email

Ordering Information

The following field is

required

Are purchase orders required to clear invoices for payment?

The following field is

required

Are purchase orders required to clear invoices for payment?

If yes, please enter their name(s)

Do you have a Cost Centre Code? If so, please complete:

Which Philpotts shop is nearest to you?

Please confirm you have agreed to the Terms & Conditions and that all the information provided in this application is complete and accurate