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
“Thank you SO much for supplying us with our Careflex chair – it arrived this morning, and we have already sat the gentleman out in it”

Occupational Therapist, Stoke-on-Trent
“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
“I must say that you have been very attentive and speedy in communicating with me, it really has been a pleasure doing business with Premiere Healthcare”

Private Customer
“Andrew, I can’t thank you enough for the excellent, person centred and flexible approach you have provided for my client, you have been nothing short of excellent”

Wiltshire OT