Medical Supplies from DNS

To apply to Dorset Nursing Supplies for a Credit Account please complete the form below and press the 'Apply' button at the bottom of the form.	Application for a Credit Account
Please fill out all areas (Hint: Use the Tab key to move from field to field)
Your Name
Trading Name
Your Position
Business Address
Business Telephone no.
Business FAX number
Email address
Limited Company Reference Number
Please provide the names and addresses of Director(s) / Partners / Proprietor
Name 1
Address
Name 2
Address
Name 3
Address
Name 4
Address

Please provide information about your Bankers and your bank account details.
Bank Name
Branch Address
Branch Sort Code format 99-99-99
Your Account Number

Please provide the name, address and telephone number of two independent traders that Dorset Nursing Supplies may contact for references.
Name 1
Address
Telephone no.
Name 2
Address
Telephone no.

Tick the box if you would like us to send you a copy of your Application.

I/We apply for credit facilities and understand that settlement is required within thirty days of date of invoice and that interest will be charged on overdue accounts. I/We acknowledge and accept all other terms and conditions as published in the supplier's catalogues and other media.

3 Wickham Road, Boscombe, Bournemouth BH7 6JX. Tel: 01202 425070 Fax: (01202) 418332
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© 2000-2008 Dorset Nursing Supplies (DNS) and Atonic Ltd.