SETUP.CO.UK - Central London
Suite 501, International House, 223 Regent Street,
London W1B 2QD
Telephone: 020 7544 1000 Fax: 020 7544
1090
EMail: info@setup.co.uk
CONFIDENTIAL APPLICATION FORM
| PERSONAL
NAME(s): Please give ALL names in which mail/messages will be received |
__________________________________________________________ |
| COMPANY
NAME(s): Please give ALL names in which mail/messages will be received |
__________________________________________________________ __________________________________________________________ |
| ADDRESS: | __________________________________________________________ |
| TELEPHONE (Home): | _______________________________ |
| TELEPHONE (Work): | _______________________________ |
| EMAIL: | _______________________________ |
| SERVICE(s) REQUIRED | (tick as required) |
| MAIL SERVICE: | HOLD [ ] FORWARD [ ] |
| TELEPHONE SERVICE: | HOLD [ ] |
| EXCLUSIVE TELEPHONE: | HOLD [ ] |
| FULL
SERVICE: (Mail,Phone and Fax) |
HOLD [ ] FORWARD [ ] |
| EXTRA NOTES: | __________________________________________________________ |
| START DATE:____/____/_____ | FOR ________ MONTHS |
| PAYMENT AMOUNT: | £________________ Cash / Cheque / Visa / Master / Switch / Solo (All CC 5% SURCHARGE) |
| Cardholder Name: | _______________________________ (if different from above) |
| Credit Card No.: | _______________________________ |
| Issue No: _______ | Expiry: _____/_____ (mm/yy) |
A deposit is required in advance to cover postage and fax costs for the forwarding service.
SIGNATURE
:_______________________________ DATE:__________________________
(Please
return this form/payment to the company/address at the top of this form).