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.

“I wanted to say how happy we are as a Company with not only the quality of the products you have supplied, but in the professional approach during the assessment and also the aftercare service”

Paula Lewis (Director, Fieldbay Group)
“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
“Thank you Annabell for all your support in helping identify suitable equipment for my client's complex needs”

Pembrokeshire OT
“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