Account form – Modi Brothers

MODI BROTHERS UK LTD

Trade Account Opening Form

Full Name *

Company Name *

Company Address

Company Registration No.

VAT ID

Delivery Address (if diff. from above)

Manufacturer Distributor Wholesaler Retailer Builder Architect Interior Designer Contractor Others:

Phone (Work)

Phone (Mobile) *

Email *

Website

I/We confirm that the information provided is true and correct and request to open a trade account with Modi Brothers UK Limited.

Authorized Name *

Position

Signature (Type Name) *

Date *