New Customer Setup Form

For assistance in completing this form, please contact accountsreceivableuk@belkin.com.

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 Line 1

Address Line 2

Town/City

Postal Code

Contact Name

Company Name 2

Address Line 1

Address Line 2

Town/City

Postal 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

Phone Number

Buyer/Key Contact Person

First Name

Last Name

Job Title

Phone Number

Fax Number

Sales Manager

First Name

Last Name

Job Title

Phone Number

A/C's Payable Contact

First Name

Last Name

Job Title

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

Acceptance of Terms (Managing/Finance Director or Partner)

First Name

Last Name

Job Title

Belkin Ltd Online Terms and Conditions

By submitting this form you agree to the following:

Personal data supplied to Belkin will be processed under the terms of Belkin's privacy policy

All business conducted with Belkin will be solely on the basis of Belkin's General Terms and Conditions of Business, unless and until Belkin has signed a legally binding agreement with yourselves, in which case such agreement will apply to the exclusion of the General Terms and Conditions of Business.

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

Sign in

New Customer Setup Form

Company Information

Billing Address

Delivery Address

Trade References

Financial Information

Goods In Details

Buyer/Key Contact Person

Sales Manager

A/C's Payable Contact

Additional Information

Acceptance of Terms (Managing/Finance Director or Partner)

Belkin Ltd Online Terms and Conditions