Credit Account Application

Account Information

Account Name: *

Trading Title/Registered Business Name:

Address: *

Eircode: *

Telephone Number:

Mobile Number: *

Contact Name: *

Date of Birth: *

Email Address: *

Business Type: *

Number of Years Trading: *

For Limited Companies Only

Company Registration Number:

Date of Incorporation:

Registered Office Address:

Name and Address of Directors (including Date of Birth):

Have directors traded under any other name(s) (Associated Companies)? If yes, please provide details:

General Details

Are you exempt from VAT? *

Exemption Number & Expiry Date:

Credit Limit Required (€): *

Submission of this form demonstrates acceptance of the terms and conditions of sale of Drinagh Co-operative Ltd. Once we have completed our standard account application checks, you will receive confirmation of your account status. Once your account has been created, you will be required to sign a copy of this application in branch, and in the case of Limited companies, will also be required to sign a personal guarantee.