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
“Sandy's Hydro Tilt has been safely delivered to No. 11 Greenhills Road, and everyone is so pleased to have it”

Maggie Gibson, Private Customer
“On the recommendation of the professionals who care for my mother, we recently contacted Premiere Healthcare regarding buying a more supportive chair”

Customer
“On the recommendation of the professionals who care for my mother, we recently contacted Premiere Healthcare regarding buying a more supportive chair”

Private Customer – East Midlands
“I really value your input in these stressful times”

Occupational Therapist from South Wales