Company Name

Address
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Registered Office
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Co. Registration No.

Business Name

Business Address
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Full Name

Home Address
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Partners Full Name

Home Address
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Address
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DECLARATION
I / We warrant that the above information is true and have read, accepted and retained the Terms and Conditions. Credit facilities will not be granted until the application form is fully completed and references taken up and reviewed. Ribble Fuel Oils reserve the right to decline any application without giving reason. Credit limits and payment terms must be adhered to and must not cannot be exceeded. Periodical reviews will be carried out on account activity. Accounts which are dormant for more than four months will be disscontinued and can only be re-opened on re-application. Failure to comply with our Terms and Conditions will result in withdrawal of credit facilities and any sums outstanding will become payable immediately. We reserve the right to amend credit facilities, Terms and Conditions or to withdraw credit facilities at any time.

SIGNED .............................................................................................
TITLE / POSITION .............................................................................
DATE ..................................................................................................

In the case of a company, this form must be signed by a Director, Company Secretary or authorised signatory.

(F) Request for a bank Reference / Status Enquiry

To:
Bank: ................................................................................................................................
Address: ...........................................................................................................................
.........................................................................................................................................
A/c No: .................................................... A/c No: ............................................................

We hereby authorise the rise by Hermon Hodge Ltd T/A Ribble Fuel Oils for a current status enquiry and any such future enquiries they may wish to make.

Signed: .................................................... Name: ..............................................................

Please complete the Direct Debit form. Originators Identification Number: 854111

To the manager.................................................................................................................. .........................................................................................................Bank/Building Society
Address.............................................................................................................................
.........................................................................................................................................
....................................................................................Postcode.......................................
Instruction to your bank or building society to pay direct debits.
Please complete parts 1 to 4 intruct your branch to make payments direct to your account. Then return the form to: Ribble Fuel Oils, 281 Carnfield Place, Walton Summit, Bamber Bridge, Preston, PR5 8AN.
1. Please write the full postal address of your branch in the box above.
2. Name of account holder...................................................................................................
3. Account Number...........................................................................................................

Banks/Building Societies may refus to accept instruction to pay Direct Debits from some types of accounts.

Customers Name: Hermon Hodge Ltd. T/A Ribble Fuel Oils
Customer Reference: ____________________________________________________________

4. Your instuctions to the bank/building society, and signature.
• I instruct you to pay direct debits from my account to the request of Ribble Fuel Oils.
• The amounts are variable and may be debited on various dates.
• I understand that Ribble Fuel Oils may change the amounts and dates.
• I will inform the bank/building society in writing if I wish to cancel this instruction.
• I understand that if any Direct Debit is paid which breaks the terms of instruction, the   bank/building society will make a refund.

Signatures(s) ________________________________________________________________________________
Date ________________________________________________________________________________