New customers

Apply for a credit account

Complete the form below and our accounts team will review your application. Opening an account is subject to credit approval.

01Complete your business details
02Submit the application securely
03We will contact you after review

01Business details

Trading / company name * Registered name, if different Company registration number VAT registration number Business type * Other business type Trading address * Town / city * Postcode *

02Contacts

Main contact * Telephone * Accounts contact * Accounts telephone Invoice email address * Purchase order required? *

03Credit request

Credit limit requested (£) * Payment terms requested * Other payment terms Bank name Account name

04Trade reference Optional

Business name Contact name Email or phone Account held since

05Declaration

I confirm that I am authorised to apply for a credit account on behalf of the business named above. I confirm that the information supplied is accurate and agree that Midland Truck Tech may undertake reasonable credit checks. The applicant agrees to Midland Truck Tech's Terms and Conditions of Business and to pay invoices within the terms approved in writing. Any requested credit limit or payment term is subject to approval and may be varied or withdrawn.

Authorised name * Position * Application date * I confirm that I am authorised and accept the declaration above. *

Your application will be emailed to our accounts team. We use your information only to assess and manage your account application. See our privacy information.