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New Customer Setup Form

For assistance in completing this form, please click here

Company Information *Required Field

*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 Name1:

Address Line 1:

Address Line 2:

Town/City:

Post Code:

Contact Name:

Company Name 2:

Address Line 1:

Address Line 2:

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:

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