Account Application

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Account Types

Account Application

Application Form

Please fill in the form below and we will get back to you.

* Indicates Required Fields

Contact us

Account Type Required*

Monthly Credit Account

Cash & Carry Account

Payment on Order Account

Name/Company Name*

First Line of Address*

Postcode*

Phone Number*

Email address*

Contact Name

Year Co began trading

Please provide at least one trade reference

Collection, Delivery or Both?*

Collection

Delivery

Special Instructions

Order Number Required

Order Reference Required

Emailed Order Acknowledgements

Email Invoices/Statements (Monthly Credit Accounts only)

Email Address for Order Acknowledgements (If required)

Email Address for Invoices/Statements (Monthly Credit Accounts Only)

I hereby apply for a Credit Account and confirm that:*

All information provided above is correct

That I/We have read and agree to the company’s terms & conditions of trade and will settle all accounts within your stated credit terms

That I/We agree to having a credit check taken in relation to this application

Thank you for contacting us.
We will get back to you as soon as possible

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Opening Hours

Mon - Fri: 7:45 am - 4:30 pm
Sat - Sun: Closed

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About Us

Terms & Conditions

Bromyard Glass Ltd, Glendower Road, Leominster, HR6 0RL

Tel: 01568 614611 | Email: sales@bromyardglass.co.uk

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