Please take a little time to enter your business details here if you have not used us before. You only have to use this form once. PLEASE NOTE THIS FORM IS ONLY COMPATIBLE WITH IE4 AND ABOVE OR NETSCAPE.

(*) = required infomation.

Title	Mr Mrs Ms Miss Dr Rev
First Name (*)
Surname (*)
Company Name (*)
Position (*)
Address (*)
Address (*)
Town
Postcode (*)
Telephone (*)
Fax
E-mail (*)
Type of Business (*)
Is your Company	Limited (*) Registration Number
	PLC
	Partnership/Firm
	Full Name   Address 1 (*)   (*) 2   3
	Sole Trader
	Owners full name (*)   Address (*) 1
Do you Provide (*)	Goods and Services
	Services Only
	Goods only
	Other
Have you ever used Thomas Higgins & Co before (*)	Yes
	No
	If yes what is your account number
Where did you hear of Thomas Higgins & Co?	Recommended Google Yahoo Other web search The Web Direct Mail Credit management 25 Year Brochure Been a TH & co Debtor Direct Contact LBA Offer Other
If Other
How many debts do you have outstanding at present?	1 - 5 5 - 10 10 - 15 15 - 30 30 - 100 Over 100
(*) I confirm I have the Authority to open a 7 day credit account with Thomas Higgins & Co
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