Fisher Scientific Ireland- Laboratory supplies and chemical manufacturing

Fisher Scientific Account set-up

Company Registration Number

Your details & Address of Paying Office
Title
First name	*
Surname	*
Company	*
Department
Country
Address (Street/Road)	*
Address Line 2
Address Line 3 (Area)
Address Line 4 (Post Town)
Postcode
Telephone	*
Fax
Email Address	*

Is your registered company office address the same?

Name & Address of Registered Office
Company	*
Country
Address (Street/Road)	*
Address Line 2
Address Line 3 (Area)
Address Line 4 (Post Town)
Postcode
Telephone	*
Fax

Is your invoice address the same?

Name & Company invoice address
Company	*
Country
Address (Street/Road)	*
Address Line 2
Address Line 3 (Area)
Address Line 4 (Post Town)
Postcode
Telephone	*
Fax

This Concern is constituted as?
Sole Proprietorship
Partnership
Company with Unlimited Liability
Private/Public Company with Limited Liability

The Principals of the Concern and Directors
Name:	Job title
*	*
*	*
*	*

Trade Reference (Both to be completed)
1
Title
First name	*
Surname	*
Company	*
Country
Address (Street/Road)	*
Address Line 2
Address Line 3 (Area)
Address Line 4 (Post Town)
Postcode
Telephone	*
Fax
Email Address	*

2
Title
First name	*
Surname	*
Job Title
Company	*
Country
Address (Street/Road)	*
Address Line 2
Address Line 3 (Area)
Address Line 4 (Post Town)
Postcode
Telephone	*

Required credit limit

Declaration
The above information is given in confidence and to my knowledge is accurate in all respects. We confirm acceptance of your payment terms of 30 DAYS from invoice date.

Please tick to accept the above declaration *

Instructions
Fields marked with * are mandatory. Please complete the form to the left to start the set-up of your Fisher Scientific account. Address details: It is important you complete your full details and company address for your paying office, registered company office and invoice address. This will help us in our validation process of your account.
The Principals of the Concern and Directors: Please be aware that we may make a search with a credit reference agency, which will keep a record of that search and will share that information with other businesses. We may also make enquiries about the Principal Directors with a credit reference agency
Trade References: We require you to complete two trade references before we can authorise your account.

Process
	Complete the on-line account set-up form
	Fisher Scientific Ireland will validate your details. This may include running credit checks and further research into your companies activities.
	If your account is authorised you will be sent your account number.
	Once you have your details you can start to order through our catalogues, or online*.
*You will need to complete a registration form for access to our online catalogue.