Online Account Form - Ambiance Bain UK

ONLINE
ACCOUNT FORM

Online Account Form

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Agent Name*

Company Name*

Trading As*

Is the Company*

Sole Trader

Partnership

Limited Company

Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Company Reg No*

V.A.T No*

Telephone Number*

Company Email*

Owner Details

Owner*

Contact Number*

Email*

Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Showroom Manager Details

Showroom Manager*

Showroom Number*

Showroom Email*

Accounts Details

Accounts Contact*

Contact Number*

Contact Email*

Office Hours*

Invoice Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Delivery Details

Delivery Hours*

Delivery Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Banking Information

Bank Name*

Sort Code*

Account Number*

Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Trade Reference

Comany Name*

Address*

Street Address Address Line 2 City County / State / Region Post Code Country

Contact*

Telephone No*

Please note: Signatory must be a Co-director, Partner or Proprietor

I acknowledge that I have read and understood the Standard Terms and Conditions of Trading and I accept they set out the terms on which MIMEA UK LTD will supply goods and services to the customer.

Customer Authorised Signature*

Signatory Name*

Date*

Position*

Consent*

I consent to my submitted information being stored by Ambiance Bain so they can respond to my enquiry.

Furniture

Showers

Finishing Touches

Modular Furniture

Tailor-Made

Fitted Furniture

Shower Spaces

Shower Trays

Complementary Items

Komplements

Your Project

Inspiration

Help

Resources

Owner Details

Showroom Manager Details

Accounts Details

Delivery Details

Banking Information

Step into style with Ambiance Bain.
your bathroom journey begins today.

Owner Details

Showroom Manager Details

Accounts Details

Delivery Details

Banking Information

Step into style with Ambiance Bain. your bathroom journey begins today.

Step into style with Ambiance Bain.
your bathroom journey begins today.