New Account Online Application Form

Thank you for placing your fertiliser order with Thomas Bell.

In order for us to move to the next stage, we need to perform our FIAS and credit checks. This shouldn't take too long and to help make things easier, we have created the online form below. From October 1st, farmers will need to provide a photo identification for purchasing Ammonium Nitrate with nitrogen content of 16% or above. Photo ID can include a passport or driving licence and suppliers must record and retain this information for 18 months.

‍Please complete the form and click submit, we will then be in touch once your application has been approved and arrange for delivery of your fertiliser.

FIAS SECURITY CHECK / CREDIT APPLICATION

FARM TRADER / AGRONOMIST NAMEFULL TRADING NAMEVAT ACCOUNT NUMBERTitlePRIMARY CONTACT NAMEaDdress line 1aDdress line 2cOuntyINVOICE POSTCODEDELIVERY ADDRESSTELEPHONE NUMBERMOBILE NUMBEREMAIL ADDRESSLEGAL ENTITYNUMBER OF YEAR ESTABLISHED

BANK REFERENCES

BANK NAMEBANK ADDRESSDURATION OF RELATIONSHIP

TRADE REFERENCE 1

We require two trade references to open your account from either a tractor supplier, country store, vets or animal feed suppliers.

Company name - trade ref 01contact name - trade ref 01address - trade ref 01tel no - trade ref 01account open since - trade ref 01CREDIT LIMIT - trade ref 01

TRADE REFERENCE 2

Company name - trade ref 02contact name - trade ref 02address - trade ref 02tel no - trade ref 02account open since - trade ref 02CREDIT LIMIT - trade ref 02

Agreement to the Company’s Terms and Conditions of Sale

1. I have read and understood the Company’s Terms and conditions for the Supply of Goods and Service and agree to abide by them
2. I am aware that the Company must be notified of any discrepancies or queries as follows:
a. Invoice queries or Product quantity / quality or description problems – as soon as possible, preferably within 3 days of receipt.
3. I confirm acceptance of the Company payment terms of 28 days from date of invoice
4. I give my consent to a credit search being made on me as owner/partner or director of this organization both now & at any future date.
5. Information will be used to determine purchases are by bona fide farmers / Contractors

ELECTRONIC SIGNATUREPOSITION IN THE COMPANY

UPLOAD PHOTO IDENTIFICATION

Upload PASSPORT / ID

Max file size 10MB.

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fileuploaded.jpg

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DATE

COMMUNICATION PREFERENCES:

We would like to send you updates about our products & services, news & events by email, post, SMS and other electronic means. We’ll always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Please let us know if you would like us to contact you or not by selecting one of the options below.

Thank you! Your application has been received!

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