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BANK DETAILS

PERSONNEL DETAILS

NAME & ADDRESS OF TWO PRINCIPAL SUPPLIERS IN UK

PLEASE STATE CREDIT LIMIT REQEESTED

Up to £1,000  

Up to £2,000  

Up to £5,000  

Up to £10,000  

I have read and accept Intermedia Terms of Service:

*By signing this form you are agreeing to Intermedia contacting the principal suppliers provided above, taking up bank references and conducting credit checks with credit reference agencies, or any other agency as deemed appropriate by us.

Credit checks will be carried out periodically whilst your account is active with us. This may have an affect on the credit limit given.