To help us direct your account to the correct department please confirm the following:

Fields marked with an asterisk (*) are required

What type of tile related business are you?*
-- Choose type of business --Sole trader tilerCommercial fixerContractorRetail outletOther

How did you hear about us?*

First name*

Last name*

Business name*

Email*

Mobile number*

Alternative number

Addresses:

Business address*

Address 2

Town/City*

County*

Postcode*

Delivery address (if different to business address)

Address 2

Address 3

Town/City

County

Postcode

Delivery contact name

Delivery contact phone

Site access information

About the Business:

How long have you been in business (years)?*

Name(s) of partners or directors (please list all partners/directors here, if none, then enter 'None')*

VAT registration number

Company registration number

Bank Details:

Bank name*

Bank address*

Address 2

Address 3

Town/City*

County*

Postcode*

Account name*

Sort code*

Account number*

Required monthly credit (£)*

Any other information

I have read and agree to the Euxton Tile Supplies Terms and Conditions of Sale.

I consent to having Euxton Tile Supplies store and use my details in accordance with the privacy policy.