Company Name *

Address *

Address 2

Address 3

Town/City *

Post Code *

Telephone No. *

Fax No.

Email *

Company Reg No.

Established (year) *

Accounts Payable Contact *

Accounts Payable Email *

Accounts Payable Phone *

Delivery Contact *

Delivery Address *

Delivery Address 2

Delivery Address 3

Delivery Town/City *

Delivery Post Code *

Delivery Telephone No. *

Delivery Fax No.

Delivery Email *

Are purchase orders required to clear invoices for payment? *
Yes No

Are other people authorised to order on this account? *
Yes No

If yes, please enter name(s)

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

Which Philpotts shop is nearest to you?
Your nearest Philpotts Shop Birmingham - Bennetts Hill Birmingham - Colmore Circus Birmingham - Edgbaston Birmingham - Great Charles Street Bristol - Marsh Street Bristol - Temple Quay Bristol - Victoria Street Chester Edinburgh Leeds - Bridgewater Place Leeds - St Pauls Street Liverpool - Brunswick Street Liverpool - Exchange Flags Manchester - Brazennose Street Manchester - City Tower Manchester - Lowry House Manchester - Mosley Street Manchester - Portland Chambers Nottingham Sheffield Shrewsbury

How did you hear about the Philpotts Credit Account?