Returns

If you would like to apply for a business or trade credit account, please complete your details below.

Once we have agreed your credit terms, we will add a pay-by-credit-account option to the checkout page of your online account.

Please note that by submitting this form you will be subjected to a credit check through an authorised credit bureau. All partners, sole traders & a named director with Companies House will be required to provide a valid form of identification to complete the application process. Details will be provided by our Accounts Department.

If you wish to download a pdf version please click here

For full credit terms and conditions please click here.

1. Applicant/Account Holder Details

Company Name

Trading Name (if applicable)

Type of Business

Postcode

Address

Town/City

Country

Telephone

VAT Registration

Company Registration

Structure of Business (partnership, PLC etc)

Economic Operator Registration and Identification Number (EORI)

Do you already have an Account with Us?

Yes

Sales Person Contact

2. Invoice/Delivery Address (if different to above)

Invoice Postcode

Invoice Address

Invoice Town/City

Invoice Country

Email Address (order confirmation)

Delivery Postcode

Delivery Address

Delivery Town/City

Delivery Country

3. Finance Department Contact

Name

Telephone

Email Address (for Invoices and statements)

Designation

4. Director/Partner/Proprietor Details

Name

Please submit the details of all active directors/partners. Where the applicant is a sole proprietor/partnership, please provide a residential address.

Postcode

Address

Town/City

Country

Designation

Name

Postcode

Address

Town/City

Country

Designation

Name

Postcode

Address

Town/City

Country

Designation

5. Credit Application Agreement

Credit Limit Requested

Minimum credit limit value requested is £500. Payment terms are strictly net 30 days from statement unless otherwise agreed in writing.

To download a manual version of the returns form for you to complete please click here and email the completed form to customer.services@polycohealthline.com.

Contact Us

1. Applicant/Account Holder Details

2. Invoice/Delivery Address (if different to above)

3. Finance Department Contact

4. Director/Partner/Proprietor Details

5. Credit Application Agreement

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CUSTOMER SERVICES