Bermans Company Client Registration

1. About your company

Name of company (including trading title)*

Full trading address*

Street Address Address Line 2 City / Town Region Post Code Country

Registered office address (if applicable)

Street Address Address Line 2 City / Town Region Post Code Country

Billing address (if different from trading address)

Street Address Address Line 2 City / Town Region Post Code Country

VAT Number

Company registration number

Tax reference number

Nature of your business

Main Telephone*

Main Fax

Primary Contact*

Direct Dial

Mobile

Email*

Additional authorised contact

Direct Dial

Mobile

Email

Name and full postal address of your Bank / Building Society*

Name(s) of Account Holder(s)*

Account number*

Branch sort code*

Signed

Accepted file types: jpg, jpeg, png, gif.

Upload a digital version of your signature

Print name*

Date*