This form once completed will be sent directly to our credit team.


View our Terms and Conditions before filling this form in by clicking here.


To make an enquiry with us please complete the form below.
* required fields
( please fill these fields in )
 Company Details 
company: *
address: *
 
post code :*
email:*
tel: *
 
 Business Details 
status: *
Ltd Plc Sole Partner
  company registration number
 
  registered office address (if different from above)
address:
 
post code:
  type of business
 
 
 Services Used 
  (Please tick)
Skips / Roll-on Roll-off
Tippers / Grab Lorris
Hazardous Waste/ Asbestos Removal
Tankers / Gully Suckers / Sweepers
Containers / Office Space / Fencing
Plant Hire
 

Value of skips used over a month period: £
(approximate)
Accounts payable contact:
Do you use order numbers?
 
 Company Director/Officer 
name: *
 
 Comments 
  Leave any comments regarding your application here
 
   
I agree to the terms and conditions of trade set out by Countrywide Waste Mangement Ltd and all information provided is accurate as possible.
 

 

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