Business Partner Application Form - Daisy Distribution

Business Partner
Application Form
For office use only:
Date opened:
Main contact / Invoice details
Date received:
Account manager:
Sales support:
Company name:
Trading name (if different)
Address:
Postcode:
Main contact:
Telephone:
Email address:
Number of outlets:
VAT number:
Fax:
Company registration number:
Date established:
Registered address (if different)
Postcode: Company credit card? Yes/No Credit limit: £
Type of Partnership/ Plc Ltd Retail B2B Distance
business: Sole Trader
Additional outlet details
Address 1:
Postcode:
Tel: Fax: Email:
Address 2:
Postcode:
Tel: Fax: Email:
Please complete all requested information and ensure all are dated together with:
(Please tick when complete)
Director Indems if Ltd Company
Completed bank status form
Copy of recent bank statement
VAT Self billed agreement
Copy of VAT certificate
Letter headed paper attached inside
Interior and exterior photos
Orange
O2
Vodafone
Networks you wish to trade with
(Please tick below)
Please note once your trade account is open we will apply for
your network codes. Approval for these are at the discretion of
the network.

Proprietors / Partners / Directors
details
Note: If Sole Trader / PLC Please complete details 1
If Limited Company 2 Directors details are required, please complete both details 1 and 2
Details 1 Details 2
Full name:
Date of birth:
Address:
Full name:
Date of birth:
Address:
Postcode:
Postcode:
Home telephone:
Mobile number:
Home telephone:
Mobile number:
Personal credit card? Yes/No Credit limit: £ Personal credit card? Yes/No Credit limit: £
How long at present address:
owned/ rented other
mortgaged
how long at present address:
owned/ rented other
mortgaged
Details of previous address (if less than 3 years at present)
Address:
Address:
Postcode:
Postcode:
How long at address:
owned/ rented other
mortgaged
How long at address:
owned/ rented other
mortgaged
All personal details provided within this form will be used by Anglia Telecom Centres for personal credit checks.
How did you hear about Anglia Telecom Centres?
Trade Press Cold Call Word of Mouth Internet Network Referral
Other (please state):
__________________________________________________________________________________
Please give details of any previous trading within the mobile and communications industry:

Automatic payment by bank
transfer form/ business bank account details
To enable us to implement payment to you direct by Bank Transfer for monies owed please can you complete your
current bank details below. This account must match bank status form and any bank statements provided.
Account Holder name
Bank Name
Bank Address
Post Code
Sort Code
Account Number
(8 digit number to be used)
Federation of Communication Services Ltd –
Mobile communication crime prevention scheme
All partners must comply with the rules of the Mobile Communications Crime Prevention Scheme
established by the Federation of Communication Services Ltd.
Business partner on line account
To have your account enable on the Anglia Telecom Centres Business Partner connection enter your details below.
Email address:
Password
Partner Name
Contact name:
Contact phone:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________ ________
__________________________________________________________
If you have any queries in regards to this service please contact your account manager. Once your account has been
opened, further details will follow.
I apply to become an authorised Anglia Telecom Centres partner and confirm that the above information is complete and
accurate and to be bound by the Terms & Conditions of Anglia Telecom Centres.
Signature ___________________________________
Position _______________________________
Print name __________________________________
Date _________________________________
Once your application has been received with paperwork listed a decision will be made within 7 working days.

For office use only
Photographs of outlet
interior
exterior
Bank ref match:
VAT Self Billing Agreement
Credit assessed
Account reconciliation
Photo’s
Letterhead
Web Application
Dealer visit report
Directors indemnity
Bond
Account ref.
Account / dealer nos
Credit limit terms:
VAT certificate received
VAT verified
Orange
Business Manager comments:
Register: Yes/No
Sent:
PIN nos
Certificate raised:
O2
Business Manager comments:
Register: Yes/No
Sent:
PIN nos
Certificate raised:
Vodafone
Business Manager comments:
BDF
Anglia Telecom Centres
Communications House
166 Handford Rd
Ipswich
Suffolk IP1 2BH
Approved by
Register: Yes/No
PIN nos
Sent:
Certificate raised:
Financial Controller:
Date:
Managing Director:
Date: