FORM

Title: General Account Application (“Non-Pharmaceuticals”)

Code: F-37-GEN

Details
Company Type Limited PLC Sole Trader

Company Name Trading Name

Registered Address
(not for input on NAV)

Company Registration No. VAT No.

Details Required for Trading
Trading Address

(For input on NAV)

Delivery / Collection Address

(If different from the above)

Contact Details
Commercial Name:

Phone:

Email:

Finance Name:

Phone:

Email:

Bank Details
Bank Name
Bank Address Phone

Email

Account Name Account

Currency

Account Number Sort Code

Reference (Please supply a trade reference who can verify the company activities)
Company Name

Address Phone

Email

Contact Person

Acknowledgment of Conditions:

F-37-GEN General Account Opening Form (“Non-Pharmaceuticals”) Page 1 of 2

 We give consent for Smartway Pharmaceuticals Limited to process any personal data provided in this Account Opening Form,
and agree that Smartway Pharmaceuticals Limited may use this data in a manner deemed appropriate to administer this account.
We understand this may include the exchange of information with credit agencies and other third parties for the purpose of
verifying and monitoring our account, as well as responding to requests for references from third parties.

We, the undersigned, acknowledge the receipt and agree to abide by the Terms and Conditions of trading as provided by
Smartway Pharmaceuticals Limited (found at www.smartwaypharma.co.uk). We confirm that we will not attempt to purchase
any products which could be deemed a medicinal product within the UK or our country of trade.

Signature : Name :

Date : Position :

Applicable To Non EU Customers Only:

By signing above, we confirm that all products purchased from Smartway Pharmaceuticals Limited, will not be placed back onto
the market within the European Economic Area (“EEA”).

Review – for Smartway use only

Territory
UK EEA Non-EEA (third country)

Payment Terms:

Credit Limit:

Comments / Conditions:

Approved after VAT check?

Approved by
Name Date Signature

F-37-GEN General Account Opening Form (“Non-Pharmaceuticals”) Page 2 of 2