Your name/company 

Property address

Contact Telephone number

Your email address

Payer Details - please complete the section relevant to you only

i.e. Sole Trader, Partnership or Limited Liability Company

Sole Trader

Title i.e. Mr,Mrs,Miss or Other:

Surname or Family name:

Forename(s):

Home Address:

Trading Name:

Partnership

Partnership trading name::

Please list all partner's full names and addresses:

Limited Liability Company

Company Registered Name:

Company Registration Number:

Company Registered Office:

Name Of Company Secretary:

Trading Name (if different):

Now please complete all fields in the remainder of this form

Occupation Details

When did you put stock on the property?

Your old Address:

Do you live in another part of the property?

Yes  No 

Purchase/Tenancy details:

If purchased, completion date:

If rented or leased, the date lease/tenancy commenced:

When does lease/tenancy end?

Does your rent include rates?

Yes  No 

Name and address of your solicitor:

Name and address of your landlord

Name and forwarding address of the previous occupier:

Name and address of the previous occupier's solicitor 

Payment details

Please indicate your preferred payment option:

By monthly payment cash/cheque

Yes  No  

By two half-yearly payments cash/cheque

Yes  No  

By one annual lump sum payment cash/cheque

Yes  No 

By monthly payment direct debit*

Yes  No 

By two half-yearly payments direct debit*

Yes  No  

By one annual lump sum direct debit*

Yes  No 

(* an application form will be sent with your bill)