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
“We have had incredibly positive feedback from everyone who attended the service development training, and colleagues finding the learning pods really useful and informative”

Occupational Therapy Team Lead, Wye Valley NHS Trust
“Thanks so much Nicola – for everything you do for us”

Louisa, Nursing Home Deputy Manager
“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 just wanted to say thank you for squeezing a fourth client on the day for a seating assessment at such short notice, I really appreciated it”

Occupational Therapist, St Matthews Healthcare