Bottler & Distributor Membership Application Form

Page 1 of 3

BOTTLER & DISTRIBUTOR MEMBERSHIP APPLICATION FORM

SECTION 1: APPLICANT DETAILS

FULL COMPANY NAME:
TRADING AS: (If applicable)
Head Office Address: / Contact Name:
Contact Telephone:
Contact email:
Main Company Telephone: / Main Company email:
Website:
Is the Company Limited? YES □ NO □ / If ‘YES’, Registered No:
If ‘YES’, list Shareholders:
a)
b)
c) /

If ‘YES’, list Directors:

a)
b)
c)
If ‘NO’, are you a Sole Trader? YES □ NO □ / If ‘YES’, your full name:
If ‘NO’, are you a Partnership? YES □ NO □ / If ‘YES’, state Partners names:
a)
b)
Does any Shareholder/Director/Partner/Proprietor associated with the business noted above have any
direct or indirect involvement in any other business in the water cooler industry? If ‘YES’, specify:
Is the business a member of any other UK or European trade association/body that encompasses water (Bottled, POU, Other) dispensing systems? / If ‘YES’, specify:
Indicate all activities which relate to the business:
Bottler □
Bottled Water Distributor □
POU Cooler Operator □ / Bottled Water Category & Name
Natural Mineral Water:
Spring Water:
Drinking Water:
If a Bottled Water Distributor, specify:
Bottler Name:
If a Bottler, specify address of Source and bottling plant:
Are subcontract Distributors used to service customers outside of your distribution area? / YES □NO □
If YES, ensure that Article 12 of the Bylaws is complied with.

Are all subcontract Distributors BWCA Members?

YES □ NO □ / If ‘NO’, specify Name, Address, Tel. No. and Contact of all non-BWCA Members:
(Use additional sheet if required)

Are bottled water bottle labels in conformance with all current legislation for the category of water?

(Please send samples)

/ YES□NO □

Does promotional material and website conform to the Code of Advertising & Conduct?

(Please send samples)

/ YES□NO □

SECTION 2: CRISIS MANAGEMENT DETAILS (only to be used in extreme crisis)

Contact 1:

Contact 2:

Mobile:

Home:

Email:

SECTION 3: FINANCIAL DETAILS NEEDED FOR MEMBERSHIP FEE PURPOSES:

(INFORMATION WILL BE HELD IN THE STRICTEST CONFIDENCE)

Sales turnover in the UKBottled Water Cooler industry in the past calendar year for all related products and services supplied exc. VAT:

/ £

Sales turnover in the UK Point-of-use Water Cooler industry in the past calendar year for all related products and services supplied exc. VAT:

No. of Bottled Water Coolers serviced at last calendar year-end:

(including rented, rent-free & customer owned)

No. of Point-of-use Water Coolers serviced at last calendar year-end: (including rented, rent-free & customer owned)

SECTION 4: Application for BWCA Membership supported by:
Proposer’s Name: /

BWCA Member Company:

Seconder’s Name: / BWCA Member Company:

The undersigned hereby confirms on behalf of the Applicant that at all times its business within the UK water cooler industry will be conducted in accordance with the applicable Bylaws and Codes of the British Water Cooler Association and that the turnover indicated above isa true reflection of the financial and statutory records of the business:

COMPLETED BY: / POSITION:
SIGNED: / DATE:

The BRITISH WATER COOLER ASSOCIATION Ltd, P O Box 80, Knebworth, Hertfordshire SG3 6XN

Tel: 01438 816 380 Email: Website:

VAT No: GB 578 2353 14 Registered in England No 3335335