Full Trading Name Full Trading Address Town Postcode Telephone Number Fax Number Email Address Website Name Address Postcode Contact Number Date Incorporated Number of Employees VAT Number Company Number Sales Rep Current Turnover Type of Business: Service and repairDistributionRetail / B2BWholesaleOnline Purchaser Name Purchaser Contact Number Purchaser Mobile Number Purchaser Email Address Accountant Name Accountant Contact Number Accountant Mobile Number Accountant Email Address Please provide two references Reference One Name Address Contact Number Email Address Reference Two Name Address Contact Number Email Address Please attach your company registration certificate, VAT certificate and company letterhead. PDF | JPG format only, 5MB file size limit: Marketing consent: We’d love to send you exclusive offers and the latest information from Genuine Solutions by email, post, SMS, phone and other electronic means. We’ll always treat your personal details with the upmost care and will never share, or sell them to other companies for marketing purposes. Please confirm you marketing preferences by selecting one of the options below. Yes please, I’d like to hear about your offers and latest information No thanks, I don’t want to hear about your offers or latest information. Declaration by applicant: I/We understand that the information above will be used by Genuine Solutions for evaluation purposes and that all the details provided are accurate. I/We also understand that all information supplied will be treated as confidential. I/We hereby agree that all transactions are conducted in accordance with the terms and conditions of Genuine Solutions. Sign Date I have read and agree to the terms set out in the Genuine Solutions Ltd terms and conditions.