Simmons Builders Merchants

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Self Build Account Application
Please Note: In order to process your application, this form requires a signature.
You can either print the blank form and fill in the applicable fields by hand
or use the fields to complete the form on your computer.
To print the form, press the Print this Page link and return the completed form by FAX , POST or in person to:
Simmons Builders Merchants Limited,
Old Bakery Works, Oxford Street, Mansfield, Nottinghamshire NG18 2BE
Fax: 01623 622 690
Name & Address:
Site Address:
Please check applicable items:
Extension: Single Storey 2-storey Kitchen Bathroom Garage
New Dwelling: House Bungalow Conversion:     
Expected starting date (if known): Do you have a Contractor for the build? Yes No
Contractor's Name:
Do you have plans available for which you would like a FREE computer-aided quantity estimate of building materials required for your project? Yes No
Your Contact Names: Telephone:
Fax: E-mail: Estimated credit requirements:
(amount per month)
 
Status Enquiry
A Bank Reference may be required for a Credit Account. Please complete the following. All details will remain confidential.
 
To: Your Bank/Building Society Address:
Account Name: Account Number:
Home Address:
I / We authorise Bank / Building Society to provide a Banker's opinion as below:–
Please provide your opinion concerning the ability of your customer to meet a financial commitment of
£ over months
 

TERMS & CONDITIONS OF CREDIT FACILITIES:

  1. Credit will not be granted until the application form is fully completed and signed.
  2. Terms of payment are NET PAYMENT DUE ON THE 30TH OF THE MONTH FOLLOWING DATE OF INVOICE.
  3. Interest will be charged at 2% per month on overdue accounts.
  4. I / We acknowledge receipt of the Company Conditions of Sale Schedule. (Follow the link to read and print out Conditions of Sale.)
  5. For non-incorporated businesses or private individuals, address verification and credit searches may be carried out using a recognised credit reference agency.
DECLARATION:
I/ We have read and understand the Terms and Conditions applicable to my / our application for credit facilities and agree to comply with those terms and conditions.
Signed: .......................................................................................................
To complete your application, click the PRINT button and return the printed application, duly signed, by FAX, POST or in person to the address at the top of this page. Print this Page