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sales@murraysmedical.co.uk
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Product Range
Aktiv Wheelchairs
A1 Eco
X2 SP
X2 Transit
X3 SP
X3 Pro
X5 SP
X5 Transit
X5 Plus
X6 Pediatric
The Safety Sleeper
STANDARD BLUE
STANDARD PINK
PROFESSIONAL GREY
CUSTOMISED
The Sensory Pod
Veldink4Kids
Kiddo Up
Kiddo Classic
Kiddo Tilt
Kiddo Space
Adapt
Mud Cruiser
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Apply for an Aktiv dealer account
Apply for an Aktiv dealer account
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2020-07-17T10:21:03+00:00
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1
Step 1
Applicant Business Name
Address
Contact Name
Position
Tel
Fax
Mob
Email
email
Invoice Address
(if different)
Tel
Fax
Email
email
Nature of Business
Number of years trading in current style
Company Registration Number
Company type
Sole Trader
Limited Company
PLC
Partnership
VAT Registration No
Bankers Name and address
Bankers Sort Code
Account Number
IBAN (if used)
Alternative Contacts/Sites
Name and address
Contact Telephone
Anticipated amount of credit required
Any Special Instructions
Application completed by (PRINT NAME)
Date
date_range
Signature
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Position
Opening Account Pricing
Comment
0
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