Export Account Application

EXPORT ACCOUNT APPLICATION

Step 1 of 5 – General Info

General Information

Name(Required)

First Last

Business Type(Required)

Year business established(Required)

Currency(Required)

Estimated Monthly Spend(Required)

Export accounts have proforma payment terms. If you would like to review these terms once your account is created, please contact your sales manager.

Have you traded under a different name?(Required)

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 City County / State / Region ZIP / Postal Code Country

Contact Name (trading / delivery)(Required)

First Last

Phone country code (trading / delivery)(Required)

Phone number (trading / delivery)(Required)

Mobile number (trading / delivery)(Required)

Email (trading / delivery)(Required)

Are your invoicing details different to your delivery details?(Required)

Yes

Invoicing Details

Business Name (invoicing)(Required)

Address (invoicing)(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Contact Name (registered office)(Required)

First Last

Phone country code (invoicing)(Required)

Phone number (invoicing)(Required)

Mobile country code (invoicing)(Required)

Mobile number (invoicing)(Required)

Email (invoicing)(Required)

Are your registered office details different to your delivery details?(Required)

Yes

Registered Office Details

Business Name (registered office)(Required)

Address (registered office)(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Contact Name (registered office)(Required)

First Last

Phone country code (registered office)(Required)

Phone number (registered office)(Required)

Mobile country code (registered office)(Required)

Mobile number (registered office)(Required)

Email (registered office)(Required)

Sales Contact Information

Sales Contact Name(Required)

First Last

Sales contact phone country code(Required)

Sales contact phone number(Required)

Sales contact mobile country code(Required)

Sales contact mobile number(Required)

Sales Contact Email(Required)

Proprietors/Directors/Partners Info

Please enter the info for up to 3 proprietors / directors / partners.

How many proprietors / directors / partners?(Required)

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 City County / State / Region ZIP / Postal Code Country

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 country code(Required)

Proprietor / director / partner 1 phone number(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

Proprietor / director / partner 1 signature(Required)

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

Proprietor / director / partner 2 name(Required)

First Last

Proprietor / director / partner 2 address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

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 country code(Required)

Proprietor / director / partner 2 phone number(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

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 City County / State / Region ZIP / Postal Code Country

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 country code(Required)

Proprietor / director / partner 3 phone number(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

Proprietor / director / partner 3 signature(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