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Subscription/Licence agreement (Accommodation/Residential address
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Name/s
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Title
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Home Address
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Postcode
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Country
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Email Address
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Telephone/Contact Numbers
Home
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Business
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UK Mobile (+44)
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Non UK Mobile/Cell phone
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Emergency Contact Number
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Business address (if different from above)
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Address for mail to be forwarded to (if different from above)
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Period of Agreement
From:
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To:
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(Please tick as appropriate)
Oxfordshire (Letter post only)
1 Month = £25.00
3 Months = £60.00
6 Months = £100.00
2 Months = £150.00
* NO signed for or registered post/parcels allowed or being on the Electoral Role
Wales (Letters and small parcels)
1 Month = £20.00
3 Months = £50.00
6 Months = £88.00
12 Months = £110.00
* Registered and signed for post accepted
Gloucestershire (Cotswolds) Letter post only
1 Month = £25.00
3 Months = £60.00
6 Months = £100.00
12 Months = £150.00
* Monthly and new build
Plus: £20 postage deposit (kitty) to be topped up if/when needed
Additional adults and/or services: Additonal adults joining your valid account (tick if required)
Additional adult joining main account holder's account = £20.00
Children 16 years or under = Free
Communal telephone service (House telephone number) = £60.00
Please note: If less than 3 months is taken, 1 month deposit required
Are you a UK Citizen?
Yes
No
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Nationality (if non UK)
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Occupation
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(Please tick as appropriate)
Employed?
Own Business?
Business website (if applicable)
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Retired?
Previous occupation (if retired)
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Optional
Family/Friend/Other (Additional contact/emergencies)
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Name
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Address
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Telephone number
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Mobile
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Email address
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I agree to the terms and coditions and that the post/mail received/expected/expecting at/by the residential/accommodation address/the licence/agreement will not be used for fraudulent activites, deception or anything illegal or otherwise of the UK laws
Date
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Signature
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