Customer Account Application

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Customer Account Application

Complete all sections below. All fields are required.

Contact Details

Main Contact Name *

Accounts Payable Contact *

Phone (Landline) *

Phone (Mobile) *

Email (General) *

Email (for Invoices/Statements) *

Directors / Principals

Full Names of all Company Directors / Owners / Partners *

Bank & Trade References

Bank & Branch *

Trade Reference 1 *

Trade Reference 2 *

Trade Reference 3 *

Trade Reference 4 *

Credit Account Request

Requested Credit Limit (€) *

€

Credit Checks Consent

I/we hereby authorise Lavan Quarries to make any enquiries considered necessary in connection with this credit application, including contacting banks, trade references, and credit reference agencies. I/we consent to the processing of this information in accordance with the Lavan Quarries Privacy Policy.

Signed *

Name & Title *

Date *

Declarations & Guarantees

Terms & Conditions: I/we understand that all goods supplied by Lavan Quarries are subject to the current Terms and Conditions of Sale, and by signing this application form I/we accept that those terms will govern all purchases made by or on behalf of this company. *

Data Protection: I/we acknowledge that Lavan Quarries will collect and process personal data as necessary for the performance of this business relationship, as outlined in the Privacy Policy. *

Personal Guarantee

I/we, the undersigned, personally guarantee immediately to Lavan Quarries the payment of all monies now or hereafter due by the above company. This is a continuing guarantee and shall not be affected by any indulgence or variation of terms. This guarantee may be revoked by one month's notice in writing but remains valid for all monies due at the date of revocation.

I/we agree to the personal guarantee above *

Signed (Applicant) *

Name *

Date *

Signed (Guarantor) *

Witness *

Address *

Part B — Project Notification Form

Purpose: To notify Lavan Quarries of individual jobs/projects to be supplied under an existing approved credit account.

Only complete this section if you already hold an approved Lavan Quarries account number.

Customer Details

Customer Account Number *

Contact Person for this Project *

Contact Phone / Email *

Project Details

Project / Site Name *

Site Location / Eircode *

Main Contractor *

Client *

Nature of Works *

Expected Job Duration *

Estimated Monthly Spend (€) *

€

Financing Method *

Authorised Purchasers for this Job

1. *

2. *

3. *

Purchase Order Requirements *

PO required on dockets

PO required on invoices

No PO required

Signed *

Name *

Date *

Additional Information

Sales Rep *

Notes *