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ACCOUNT APPLICATION
Step
1
of
7
– General Info
14%
General Information
Name
(Required)
First
Last
Business Type
(Required)
Please choose
Limited Company
Sole Trader
Partnership
PLC
Not-for-Profit
Year business established
(Required)
Have you traded under a different name?
(Required)
No
Yes
Under what name did you previously trade?
(Required)
Company registration number
(Required)
Charity number
(Required)
Company registration number
Company VAT number
Please enter the 9 digits that follow the prefix (eg GB)
Animal Activities Licence (AAL) No.
Website
Trading / Delivery Information
Business Name (trading / delivery)
(Required)
Address (trading / delivery)
(Required)
Street Address
Address Line 2
Town / City
County
Postcode
Contact Name (trading / delivery)
(Required)
First
Last
Phone (trading / delivery)
(Required)
Mobile (trading / delivery)
(Required)
Email (trading / delivery)
(Required)
Are your invoicing details different to your delivery details?
(Required)
No
Yes
Invoicing Details
Business Name (invoicing)
(Required)
Address (invoicing)
(Required)
Street Address
Address Line 2
Town / City
County
Postcode
Contact Name (registered office)
(Required)
First
Last
Phone (invoicing)
(Required)
Mobile (invoicing)
(Required)
Email (invoicing)
(Required)
Are your registered office details different to your delivery details?
(Required)
No
Yes
Registered Office Details
Business Name (registered office)
(Required)
Address (registered office)
(Required)
Street Address
Address Line 2
Town / City
County
Postcode
Contact Name (registered office)
(Required)
First
Last
Phone (registered office)
(Required)
Mobile (registered office)
(Required)
Email (registered office)
(Required)
Company Letterhead
(Required)
Max. file size: 128 MB.
Proof of Limited Company
Sales Contact Information
Sales Contact Name
(Required)
First
Last
Sales Contact Phone
(Required)
Sales Contact Mobile
(Required)
Sales Contact Email
(Required)
Finance Requirements
Estimated Monthly Spend
(Required)
Payment Terms Required
Proforma
Direct Debit
If Direct Debit is requested, our team will contact you to set this up.
Credit Account Required
(Required)
No
Yes
Choosing “yes” adds 17 questions to this form. If you want to speed up your initial application, choose “no” and you can then ask to apply for a credit account any time in the future. All credit applications are subject to approval.
Credit Limit Required
(Required)
Requested Terms
(Required)
7 Days
14 Days
30 Days
Sole Trader Personal Info
Please enter your personal info
Name
(Required)
First
Last
Home Address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Proof of Home Address
(Required)
Max. file size: 128 MB.
Bank or credit card statement or recent utility bill.
Phone
(Required)
Email
(Required)
Declaration
(Required)
I, the undersigned being the director/owner of the applicant company jointly and severally guarantee performance of all the company’s financial obligations to Peregrine Livefoods Limited. I also confirm having not previously been a director of a failed company or been subject to a bankruptcy order.
Signature
(Required)
Proprietors/Directors/Partners Info
Please enter the info for up to 3 proprietors / directors / partners.
How many proprietors / directors / partners?
(Required)
1
2
3
Please provide full details of all Proprietors/Directors/Partners. ALL named above must sign this application form below or the application will be rejected
Proprietor/Director/Partner 1
Proprietor / director / partner 1 name
(Required)
First
Last
Proprietor / director / partner 1 address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Proprietor / director / partner 1 Proof of Home Address
(Required)
Max. file size: 128 MB.
Bank or credit card statement or recent utility bill.
Proprietor / director / partner 1 phone
(Required)
Proprietor / director / partner 1 email
(Required)
Proprietor / director / partner 1 declaration
(Required)
I/We the undersigned being Director/Directors of the applicant Company (or partner if LLP) jointly and severally guarantee performance of all the Company’s financial obligations to Peregrine Livefoods Limited. We also confirm having not previously been a director of a failed company or been subject to a bankruptcy order.
Proprietor / director / partner 1 signature
(Required)
Proprietor/Director/Partner 2
Proprietor / director / partner 2 name
(Required)
First
Last
Proprietor / director / partner 2 address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Proprietor / director / partner 2 Proof of Home Address
(Required)
Max. file size: 128 MB.
Bank or credit card statement or recent utility bill.
Proprietor / director / partner 2 phone
(Required)
Proprietor / director / partner 2 email
(Required)
Proprietor / director / partner 2 declaration
(Required)
I/We the undersigned being Director/Directors of the applicant Company (or partner if LLP) jointly and severally guarantee performance of all the Company’s financial obligations to Peregrine Livefoods Limited. We also confirm having not previously been a director of a failed company or been subject to a bankruptcy order.
Proprietor / director / partner 2 signature
(Required)
Proprietor/Director/Partner 3
Proprietor / director / partner 3 name
(Required)
First
Last
Proprietor / director / partner 3 address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Proprietor / director / partner 3 Proof of Home Address
(Required)
Max. file size: 128 MB.
Bank or credit card statement or recent utility bill.
Proprietor / director / partner 3 phone
(Required)
Proprietor / director / partner 3 email
(Required)
Proprietor / director / partner 3 declaration
(Required)
I/We the undersigned being Director/Directors of the applicant Company (or partner if LLP) jointly and severally guarantee performance of all the Company’s financial obligations to Peregrine Livefoods Limited. We also confirm having not previously been a director of a failed company or been subject to a bankruptcy order.
Proprietor / director / partner 3 signature
(Required)
Trade reference 1
Trade reference 1 Name
(Required)
First
Last
Trade reference 1 Company
(Required)
Trade reference 1 Address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Trade reference 1 Phone
(Required)
Trade reference 1 Email
(Required)
Trade reference 2
Trade reference 2 Name
(Required)
First
Last
Trade reference 2 Company
(Required)
Trade reference 2 Address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Trade reference 2 Phone
(Required)
Trade reference 2 Email
(Required)
Bank Details
Bank / Building Society
(Required)
Branch Address
(Required)
Street Address
Address Line 2
Town/City
County / State / Region
Postcode
Sort Code
(Required)
Account Number
(Required)
Name as it appears on the account
(Required)
Declaration
Declaration
(Required)
I/We the undersigned apply to Peregrine Livefoods Ltd for a trade account and declare that the information given above is accurate. I/We are duly authorised by the business to enter into this agreement and agree to trade on Peregrine Livefoods Ltd’s Terms and Conditions of Sale and confirm that we have read the Terms and Conditions contained in this form. I/We understand that you may perform a search with credit reference agencies who will record the search and we may share informaton about the way you conduct your account with other lenders and credit reference agencies. I understand that if Auto Card payment terms are agreed to, I authorise Peregrine Livefoods Ltd to take payment from my card for orders that have been placed and will provide the relevant card details when requested. I understand that failure to adhere to the agreed terms offered will result in your account being placed on stop and being referred to debt collection agencies for repayment. Peregrine Livefoods Ltd reserves the right to charge interest on overdue amounts at 8% above the Bank of England base rates and the right to terminate this agreement without notice upon a breach by the customer of any Terms and Conditions.
Name
(Required)
First
Last
Signature
(Required)
How did you hear about Peregrine Livefoods?
(Required)
Word of mouth
Internet search
Pet Product Marketing
Practical Fish Keeping
Social media
Other
