Apply for an Account


CLIENT APPLICATION FORM

Finance Details

New Acccount Number (Office use only)
FULL REGISTERED ADDRESS
POSTCODE
CONTACT DETAILS
NAME
TELEPHONE NO.
FAX NO.
E-MAIL
CUSTOMER DETAILS
NAME
 
POSITION
I accept that your terms are 30 days net and hereby apply for a credit account. I accept your terms and conditions of trading are as published by the RHA (Road Haulage Association) and that the tariffs supplied to me have been calculated by the Rider Taxi computer grid and are zoned. The mileages between these zones may at times differ from those published by some Automobile organizations. I agree to abide by them in full. I confirm that I am authorized to make this application.
SIGNATURE
DATE
Account Name (Office use only)
BILLING REQUIREMENTS - PLEASE TICK
FORNIGHTLY  
MONTHLY  
PLEASE AUTHORISED TO BOOK
TICK FOR ONLINE BOOKING & REPORTING
HAVE YOU PREVIOUSLY HAD AN ACCOUNT WITH US?
/
Do you have any other accounts with Rider Taxi?
/
If YES, what is your account number?
Is a reference required with each booking?
/
If YES, please list? E.g. security code, purchase order number etc
METHODS OF PAYMENT
DIRECT DEBIT *
/
BACS **
/
CHEQUE
/
CREDIT CARD
/
* Information will be e-mailed on account activation
** Our Bank Details are available upon request
Please call back to +01727 828282