Due Diligence Form
Blackburn Distributions Ltd
Unit D Vision Park
How we use your details:
They are only used for internal purposes only. We do not disclose or share your information with any third parties. We have very strict data protection measures in place
Passport/Driving licence Number
Time In Business
1st Line of Address
Notes & Supporting Evidence
Why we need this information :
To show that we have complied with the EU legislation regarding the sale of chemicals & thier uses. All information is held in stric confidence and is not shared with any other third parties
Intended Use IMPORTANT - Must contain detailed description of how the product will used.
Estimated Annual Usage
Do you agree to Terms & Conditions?
Terms & Conditions
I/We hereby certify that the substance refered to above will not used for any other purposes than that shown above and will not be re-sold or supplied to any other customer unless the latter submites a declaration of use.
Signed (Please type your surname as a form of signature)