CREDIT ACCOUNT APPLICATION FORM

THIS IS A 3-PAGE DOCUMENT WHICH MUST BE COMPLETED IN FULL AND RETURNED WITH THE
DOCUMENTATION SPECIFIED BEFORE ANY EQUIPMENT WILL BE SUPPLIED

FOR USE OF NATIONWIDE PLATFORMS LIMITED COMPANY TYPE (tick as appropriate):

DEPOT No: ACCOUNT No: LIMITED

OPENED BY: LIMIT: NON-LIMITED (ie Partnership/Sole Trader)

Account OTHER (please specify)
SIC Code:
Manager:

SECTION A – ALL APPLICANTS

FULL COMPANY NAME:

TRADING STYLE (if different to above)

NATURE OF BUSINESS:

ACCOUNTS PAYABLES DEPARTMENT: BUYING AUTHORITY:

Contact Name: Contact Name:

Telephone No: Telephone No:

Mobile No: Mobile No:

Fax No: Fax No:

E-mail address: E-mail address:

SECTION B – LIMITED COMPANIES ONLY

PLEASE ATTACH A COPY OF YOUR COMPANY LETTERHEADING TO THIS APPLICATION FORM
INVOICING ADDRESS: TRADING OFFICE ADDRESS:

COMPANY VAT NO: COMPANY REGISTERED NO:

SECTION C – NON LIMITED COMPANIES ONLY (ie partnerships/sole traders)

PLEASE PROVIDE PROOF OF YOUR HOME ADDRESS BY ATTACHING A RECENT UTILITIES BILL
HOME ADDRESS: TRADING OFFICE ADDRESS:

NUMBER OF YEARS RESIDENT AT THIS ADDRESS DATE OF BIRTH

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 SECTION D – CONSTRUCTION INDUSTRY SCHEME
1. Are you CIS Registered YES NO
2. Your UTR Registration No.

SECTION E – POWERGUARD – DAMAGE/LOSS WAIVER SCHEME

TICK
Please tick the scheme PowerGuard PLATINUM for DAMAGE and LOSS (20% of hire rate) HERE
required: PowerGuard GOLD for DAMAGE ONLY (10% of hire rate)
TICK
HERE

If neither scheme is required please complete the following insurance declaration:

1. Are you insured for Hired in Plant? If not, PowerGuard Gold will be added automatically to your account. YES NO
2. Limit of Liability any one site £
3. Name of your Insurance Company
4. Your Policy Number please attach copy certificate
IMPORTANT: Membership of the PowerGuard Gold Plan is compulsory unless you provide full details of you own arrangements (either Hired-in Plant Insurance or Contractors’ all Risk)
to protect our equipment against the costs of accidental damage whilst on hire. For self-drive hires, on-road insurance is the responsibility of the hirer.

PLEASE REFER TO PAGE 3 FOR FURTHER DETAILS OF THE POWERGUARD DAMAGE/LOSS WAIVER SCHEME

SECTION F – HOW DID YOU HEAR ABOUT US?

Phone call from Nationwide Platforms Visit from Sales Representative Saw an advert/visited an exhibition

Saw a machine on site Used in previous job Information from a colleague

Other (please specify):

IMPORTANT INFORMATION

TERMS & CONDITIONS OF TRADE: I/WE accept the Terms and Conditions of the Construction Plant Hire Association Model Terms for the
Hiring of Plant and agree to be bound by these. I/WE understand that PowerGuard Gold Plan premiums will be levied should I/WE elect not to
provide alternative arrangements. I/WE understand and accept as the basis of trading the terms and conditions of 30 days from date of invoice
and that you shall reserve the right, without prejudice to any other remedies, to recover the goods when any sum due remains unpaid. In the
event that we do not adhere to your terms of trade, details of our payment performance may be passed to a licensed credit reference agency.
I/WE declare that the information provided to you in relation to this application is correct and that I/WE have had and agree your conditions of
trading. I/WE authorise you to make enquiries in relation to this credit account application at your discretion. I/WE understand that you may
refuse to open a credit account without giving a reason.

THE DATA PROTECTION ACT 2018 and the GDPR: BEFORE signing this application form, it is important that you read the notes below
which set out how we collect and use information about you for the purpose of providing credit facilities. We will make searches about you at
credit reference agencies who will supply us with credit information, as well as information from the Electoral Register. The agencies will
record details of the search whether or not this application proceeds. We may use credit scoring methods to assess this application and to
verify your identity. Credit searches and other information which is provided to us and/or the credit reference agencies, about you and those
with whom you are linked financially may be used by the Loxam Group and other companies if credit decisions are made about you, of other
members of your household. This information may also be used for debt tracing and the prevention of money laundering as well as the
management of your account. By signing this application, you agree that we can use your information in this way.

SIGNED PRINT NAME

POSITION DATED

Registered Office: Nationwide Platforms Limited, 15 Midland Court, Central Park, Lutterworth, Leicestershire LE17 4PN Registered number 2268921 England

Telephone: 01455 206704 Fax: 01455 559829 Email: new.accounts@nationwideplatforms.co.uk www.nationwideplatforms.co.uk

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