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  New Customer Setup Form  
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Company Information
Company Name:  *
Company Status:
Phone Number:  *
Fax Number:
VAT Number:
Company Registration Number:
Website URL:
Date Company Commenced Trading:
Main Activity:
Number of Employees:

Billing Address
Company Name:  *
Address Line 1:  *
Address Line 2:  *
City:  *
Region:
Country:  *
Postal Code:  *

Delivery Address
If the delivery address is the same as the invoice address click here: 
Company Name:
Address Line 1:
Address Line 2:
City:
Region:
Country:
Postal Code:

Trade References
Company Name 1:
Address:
 
Town/City:
Post Code:
Contact Name:
Company Name 2:
Address:
 
Town/City:
Post Code:
Contact Name:

Financial Information
Bank Name:  *
Sort Code:  - 
Other Bank Identifier:
Bank Account Number:  *
IBAN:
BIC (Swift Code):

Goods In Details
First Name:  *
Last Name:  *
Job Title:  *
Email:  *
Phone Number:  *

Buyer/Key Contact Person
First Name:  *
Last Name:  *
Job Title:  *
Email:  *
Phone Number:  *
Fax Number:  *

Sales Manager
First Name:
Last Name:
Job Title:
Email:
Phone Number:

A/C's Payable Contact
First Name:  *
Last Name:  *
Job Title:  *
Email:  *
Phone Number:  *

Additional Information
Monthly Estimated Buying:
Requested Payment Conditions:
Requested Credit Limit:
Do you also intend to export products purchased from Belkin?
Countries:
Payment Currency:

Acceptence of Terms (Managing/Finance Director or Partner)
First Name:  *
Last Name:  *
Job Title:  *
Email:  *

Terms & Conditions:
I declare to have received and agree to the Terms & Conditions of Sale
I declare to have received and agree to the Export Terms & Conditions
The personal and company data you provide Belkin will be used with the sole intention of doing business and business related activities. For automation purposes this information might be stored on servers located outside the UK. You can at any time object to this and request correction, modification or deletion of your data. I declare to have read and agree to this privacy statement of Belkin and I agree that my email addresses will be used by Belkin for commercial reasons.
By submission of this form you agree to Belkin Ltd obtaining credit information held by reporting agencies and trade references provided on this form.
   


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Dutch Julie D'hoedt
+44 (0)1933 352238

Italian Graziella Wolff
+44 (0)1933 352223

German Claudia Schiller
+44 (0)1933 352234

Spanish Maria-Silvia Rios-Jaime
+44 (0)1933 352239

English Becky Howard
+44 (0)1933 352232


French Graziella Wolff
+44 (0)1933 352223