Form

Full Trading Title:*

Address Line 1:*

Address Line 2:

Address Line 3:

Post Code:*

Telephone Number:*

Fax:*

Mobile Number:

Nature of Business*

Full Names and Addresses of Partners/Owners*

Dates of birth*

How did you hear about AW Lumb*

Email for Queries & Payments

Email for Prices & Quotations

Trade Reference 1*

Trade Reference 2*

Credit Required*

Application Authorised By*

Position:*

Accounts are subject to the Company's Terms and Conditions of Sale. A copy is available on request.

In considering my/our application, I/we accept that you may consult with and disclose the data to credit reference agencies, banks, credit insurers and other responsible organisations outside your business that you have nominated (“third parties”), and that such third parties may process the data. I/we understand that under the Data Protection Act I/we have a right to know what data you hold on me/us if I/we apply to you in writing and pay the applicable fee.