Thanks for choosing ELC UK LTD

To place order you should have an open account with us. Please complete this form and let us open an account for you*
*Subject to delivery route availability.

Already a customer with us? Click here!

(All * fields are mandatory)

Please enable JavaScript in your browser to complete this form.

Shop Name

Name of Owner

First

Last

Delivery Address

Address Line 1

City

State / Province / Region

Postal Code

This address is your shop's address where we can deliver your order to.

Home Address

Address Line 1

City

State / Province / Region

Postal Code

We use this address for verification purposes.

Contact Person

Mobile Number

To contact the owner.

Telephone Number

This could be for your shop.

Email Address

Confirm Email

Number of Years Established

Selected Value: 0

Delivery Instructions

Opening Time

For delivery purposes.

Closing Time

For delivery purposes.

Upload ID Card

Click or drag a file to this area to upload.

For account verification and activation purposes.

Name of Referrer or Salesman

Reference Name (If any)