Account Application

Customer Set Up Form

Please fill out the form below to enable us to set up your account.

Please note that this form allows us to set up your customer profile. It ensures we have accurate and up to date details so we can fulfil your quote and deliver goods and services to you efficiently.

Any information we capture with this form will be processed in accordance with our Privacy Policy.


  • Company Name


  • Order Placing


  • Invoicing

  • I hereby confirm that I am duly authorised to transact on behalf of the company detailed in section 1 of this form. I accept in the event of conflicting terms Premiere Healthcare Limited’s terms and conditions shall prevail.
    Business terms & conditions
    Rental terms & conditions
    Deliveries & Returns

    Premiere Healthcare trade credit terms are subject to status. Any trade credit terms we may offer will be advised once we have processed this form.

  • Clear Signature
“I wish to say a very big thank you to you for your help and assistance in this matter”

Manager, Athelstan House (Assisted Living Facility)
“I am delighted to inform you that Joyce loves her new wheel chair - she has spent up to four hours in it in the past couple of days!”

Private Customer
“We have had incredibly positive feedback from everyone who attended the service development training, and colleagues finding the learning pods really useful and informative”

Occupational Therapy Team Lead, Wye Valley NHS Trust