Personal Information

Please enter the name, email address and position within the company of the person completing this application.

Any questions relating to this application will be sent to this person, plus confirmation that the account has been approved.

Company Details

Your company name, registered address and company registration number should match those registered at companies house.

If your company is part of a larger company or group, please provide the holding company address.


Accounts Details

Payment By*

Connectix Contact

Please let us know who at Connectix referred you to the credit application form.