BNPL : Step 3

Ancrum Electronics


	Credit Application


	Product Code : PNPL Term : 36 Months Deferral Period : Up to £1000 6 months deferred period before you pay Over £1000 12 months deferred period before you pay £ 100 Minimum spend

Customer Accepts Terms


	Home Delivery

Gender :

M :

F:

Title :

Forename:

Middle Name:

Surname:

Association / Alias

Time at Address

House Name/No:

Street:

Town:

County:

Post Code:

Previous Address (if less than three years at current address)

Time at Address

House Name/No:

Street:

Town:

County:

Post Code:

Marital Status:

Nationality:

Residential Status:

Home Telephone:

Mobile Telephone:

E-mail Address:

No of Dependants:

Employment Status:

Employers Telephone:

Job Title:

Time with Employer

Self Employed/Retired/Benefits/Service ID.

Employer’s Name:

Employer's Address:

Street

Town:

County:

Post Code:

Number of Credit Cards:

Cheque Guarantee Card:

Yes No

Sort Code :

Account Number:

Name Of Bank:

Time With Bank:

Goods Purchased:

Repayment Method

DD Other

Cash Price:

Deposit:


	All prices are inclusive of VAT and delivery. Prices, special offers, delivery costs, VAT and specifications subject to change without notice. (VAT No: 345 4615 55)

Ancrum Electronics