Customer Account Application Form

Please complete the form below if you would like to become a customer of West Mercia Supplies. Please note that in general WMS can only supply the public sector, educational establishments and associated bodies. For security reasons WMS can not deliver to private addresses.

If you are an existing customer and would like access to the members section of this website please click here. You do not need to complete this form as we already have this data.

Organisation Name:

Delivery Address:

City / Town		County
Postcode

Invoice Name:
Invoice Address:

City / Town		County
Postcode

Contact Name
Telephone Number
Fax Number
E-mail Address
Password to Access Website
Please Confirm Password

Is the Organisation:
A. Local Authority Owned	Yes No
B. Intending to operate for a profit?	Yes No
C. A member of the Preschool Learning Alliance?	Yes No
D. A Registered Charity	Yes No
If you answered Yes to D, what is your registration No
Please give a brief description of your organisation:

Deliveries
Are you open for deliveries Monday to Friday, 8.30am to 4pm?	Yes No
Please give further details of your opening times eg. Closed Wednesdays:
Are you closed during the school holidays?	Yes No
Is access to your property difficult? Would a lorry or a van be more suitable?	Van Lorry

West Mercia Supplies

Telephone
01743 241130

Holsworth Park, Oxon Business Park,
Bicton Heath, Shrewsbury SY3 5HJ