Order on Account

Please only complete this form if you are a Credit Account customer, all other orders must be placed via our website as normal. Orders should be placed at least 24 hours in advance, same day orders can usually be fulfilled but cannot be guaranteed. For any queries please contact us on 0121 285 6444 or enquiries@dryiceexpress.co.uk.

Account Number *

*Usually 6 digits

Dry Ice Quantity *

Delivery Date / Time *

Date

Time

*Delivery time cannot be guaranteed as it will depend on our daily delivery route. We will try our best to deliver your order on or around the time specified.

PO Number (if applicable)

Notes

*Please state any special instructions relating to the order, i.e special delivery instructions.

Name of Person Ordering *

First

Last

By placing this order you agree to pay on credit when the monthly invoice is issued. Failure to settle invoices will result in legal action being taken via the County Court. *

I understand