Company's Registered Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company's Invoice Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicants name

First Name

Last Name

Accounts contact name *

First Name

Last Name

Purchasing contacts name

First Name

Last Name

Date of last files company accounts (Month, Day, Year)

MM

DD

YYYY

Bank Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address of that supplier

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Terms of use

Please note that credit is only given on certain products and is at the discretion of Nuco International Ltd & Nu Agencies. Any information provided on this form may be used for credit applications, tracing and prevention of fraud.

Accept

Do not accept

Acceptance *

We, the applicant as stated previously, accept Nuco International Ltd / Nu Agencies payment terms are 30 days from the end of month following invoice date (unless otherwise agreed) and accept in full Nuco International Ltd / Nu Agencies Terms and Conditions of Supply, and are authorised to do so. We confirm that, to the best of our knowledge, the information provided on this form is correct.

We accept

We do not accept

Application date *

Month / Day / Year

MM

DD

YYYY