Business Account Application

To apply for a Business Account with Mediq Healthcare UK Ltd please complete the form below.  

Please be aware we can only accept applications for accounts meeting the minimum spend criteria. Please feel free to contact us to discuss your requirements.

What happens next?

Please allow us 5 working days to review your application. We will contact you by email with your new Business Account details. Should you wish to contact us via phone for your decision, please call us on 01530 830 830 (Leicester), 0161 888 5835 (Manchester) or 028 2826 0388 (Larne).

Registered Company Name: *
Company Registration Number: *
VAT Number (if applicable):
Registered Company Address: *
Post Code *
Invoice Address: *
Contact Email Address: *
Post Code: *
Contact Telephone No.: *
Fax No.:
Delivery Address (if different to Invoice Address):
Post Code
Are hard copy Purchase Orders or official P/O Numbers mandatory? *
Invoice to Invoice Address or Delivery Address? *
Invoice submissions by post or email? *
Desired credit limit? *
PLEASE NOTE THAT OUR PAYMENT TERMS ARE 30 DAYS FROM DATE OF INVOICE
PLEASE NOTE THAT OUR PAYMENT TERMS ARE 30 DAYS FROM DATE OF INVOICE
Signed on behalf of the customer: *
Position: *
Date (DD/MM/YYYY): *
Our Privacy Notice and how we process personal data, can be found at medbis.mediq.co.uk
Our Privacy Notice and how we process personal data, can be found at medbis.mediq.co.uk