Credit Account Please fill in the online contact form below. You can also download a form here to post or fax. FULL COMPANY NAME AND ADDRESS Your Name (required) Company Registration No. (required) Address (required): Postcode Telephone: (required): Fax: Email (required): COMPANY DIRECTORS Name (required): Date of Birth: Name (required): Date of Birth (required): TRADE REFERENCES (TWO) Name (required): Tel: Address: Fax: Name (required): Tel: Address: Fax: BANK DETAILS Name of Bank (required): Account Number (required): Sort Code (required): ACCOUNT DEPARTMENT DETAILS Contact Name (required): Address: Postcode Telephone: Fax: Email: Days/Hours for Contact: In completing and submitting this Form you agree that all trading between yourselves and 2 Cousins Access Platforms Limited is subject to the CPA Construction Plant-hire Association MODEL CONDITIONS FOR THE HIRING OF PLANT (With effect from July 2011). A copy is available on request or can be downloaded from here. I agree to the CPA conditions COMPLETED BY Signature Print Name
