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.

If you have an official quotation, please enter the reference below:
Company Name
Company Name
Billing Address
Address Line 1 Address Line 2 City ZIP / Postal Code
Company Registration Number
VAT Number (if applicable)
Order Placing
Order Queries - Contact Name
Order Queries – Contact Telephone Number
Order Queries – Contact Email Address
Invoicing
Email address where we should send invoices to
Address
Street Address Address Line 2 City ZIP / Postal Code
Accounts Payable – Contact Name
Accounts Payable – Contact Telephone Number
Accounts Payable – Contact Email Address
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.
Signature*
Name
Position
Email Address

“Thank you Annabell for all your support in helping identify suitable equipment for my client's complex needs”

Pembrokeshire OT

“The chair arrived safely and has now taken centre stage in my living room”

Jonathan Page, Private Customer

“Could you please pass on some good feedback to Premiere Healthcare regarding the assessment visit”

Mr Armstrong-Sly – West Midlands OT

“We can’t thank Dan enough for leaving the chair and sling with us at the time of assessment, as Annie has been up and out of bed every day since”

Mr Dodd, Home Manager

Seating

Competitive daily rental fees on a wide range of equipment.

User Needs

Rentals

Handling & Mobility

Beds & Mattresses

Customer Set Up Form

Company Name

Order Placing

Invoicing

If you have any questions about our products or services, please get in touch

We operate within a 100-mile radius of our Tewkesbury HQ