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 contacted Premiere as I required some assistance with both access and thresholds within my house for my wife who has MS”

Graham Plimmer, 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
“This is an email to say thank you to Nicola and the Team for the brilliant customer service carried out today”

Carolyn Kilburn, Nursing Home Administrator
“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)