Account application Section 1- Company Details Company name Company type Sole Trader Limited company Partnership LLP Nature of business Industry sector VAT registration number (if applicable) Main contact number How many years has the business been trading? Number of employees Registered addressAddress Line 1 Address Line 2 Town/city Post code How did you hear about us? Section 2- Contact & Billing Details Primary contact name Primary contact phone number Primary contact email address Section 2- Contact & Billing Details Is your invoicing address the same as the company address? Yes No Accounts contact name Accounts phone number Accounts email address Purchasing contact name Purchasing contact phone number Purchasing contact email address Do you operate a purchase order system? Yes No Please note, if PO numbers are required for invoicing purposes this must be given at the time of booking. We do not accept any delays to payment where PO numbers are not provided by you. Section 3 - Business Account Usage Please tell us how frequently you intend to use our service so we can assist you most efficiently. There are no minimum booking requirements however we may decline your request if your business is unlikely to use our service regularly. Roughly how many medical appointments do you expect to book per month?* Authorised persons (names of those authorised to book appointments if you book by email/phone)* How do you want to book medicals? (tick all that apply) May we mention your company in our monthly newsletter to our business customers and on our social media channels? Yes No (We will always check with you prior to publishing any reference to your business). I hereby request that an account be opened for our business in accordance with the above particulars. Please print name to sign. Apply
