Credit Account Form

To quickly apply for a credit account with embh,
please complete and submit the form below.

Fields marked * are required

Your Details

Name * Name is required

Position * Position is required

Email Address * Please enter a valid email address Email Address is required Not a valid email address

Phone Number * Please enter a valid telephone number Phone Number is required

Business Details

Business Name * Business Name is required

Company Number

Delivery Address

Address Line 1 * Address Line 1 is required

Address Line 2

Town/City * Town/City is required

Postcode * Postcode is required

Invoice Address

Invoice address is same as delivery address

Address Line 1 * Address Line 1 is required

Address Line 2

Town/City * Town/City is required

Postcode * Postcode is required

Buyer Details

Buyer Name * Buyer Name is required

Email Address * Please enter a valid email address Email Address is required Not a valid email address

Phone Number * Please enter a valid telephone number Phone Number is required

Accounts Details

Contact Name * Contact Name is required

Email Address * Please enter a valid email address Email Address is required Not a valid email address

Phone Number * Please enter a valid telephone number Phone Number is required

Credit Limit

Credit Limit Requested (£)

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