Please complete using a Ball Point Pen and return to:

Square Deal

5 Thames Industrial Estate

High Street South

Dunstable

Bedfordshire

LU6 3HL

Alternatively scan completed fom and email to: Info@CallDE.co.uk

Business Rental proposal application form                          Date:              /         /

Business Name: ……………………………………………Nature of Business: ……………………...……………….…………………

Address of business: …………………………………………………………………….............……………………………………………

…………………………………………………………………………………………………...……………………………………………….

Postcode: …………………………

Business Telephone Number: ……………………………………………………..

Email address 1 : ……………………………………………………..

Email address 2 : ……………………………………………………..

Business web address: ……………………………………………………………………………………………………………..

Install address (if different):

Address of business: ……………………………………………………………………………………………………..........……………

………………………………………………………………………………………………………………………………………………….

Postcode: …………………………

Telephone Number: ……………………………………………………..

Years business been running: ……….Yrs        ………….. Months

Has Business got Contents insurance which would cover rental product(s)

Y/N (delete where not applicable)

Business Type:           Ltd / Partnership / Sole trader      (delete where not applicable)

Name of person in charge and allowed to sign paperwork:

Title: Mr / Mrs / Miss / Ms / (Other) …………    (delete where not applicable)

First Name: ………………………………………    Surname: ………………………………………………….

Position: …………………………………..

Mobile Telephone Number: ……………………………………………………..

If business Sole trader, Partnership or established less than  5yrs we will need home add of Owner / Director.

Home Address: ………………………………………………………………………………………………....................…………………

………………………………………………………………………………………………………………………………………………….

Postcode: ……………………………              Time at present address:     ……….Yrs        ………….. Months

Personal Telephone No: ……………………………… / Personal Mobile Telephone No: ……………………………

If living at present address less that 3yrs please give previous address:

Home Address: ……………………………………………………………………………………………………....................……………

………………………………………………………………………………………………………………………………………………….

Postcode: ……………………………              Time at this address:     ……….Yrs        ………….. Months

Equipment Required:

……………………………………………………………………………..........     Monthly Price quoted      £         .                 Qty:…….

………………………………………………………………………………….      Monthly Price quoted      £         .                 Qty:…….

……………………………………………………………………..…………....     Monthly Price quoted      £         .                 Qty:…….

Administration Fee quoted:        £         .                               Installation fee Quoted       £         .

         Insurance Fee Quoted:        £         .

Payments by monthly Direct debit or annually. (If paid annually 1 month discount applies)

Bank Account Details for Direct Debit:

Name of Bank: …………….…..…………  Account Number: ………………….……………….  Sort Code: …………………………….

Name account held in: ………………………………………………………………………

Card Details for initial Payment (If required): .....................................................................................

Date equipment required:              /              /20                          Time: ………………………………AM / PM

Has property got the correct electrical supply and plumbing installed

Y/N (delete where not applicable)

Do product(s) need to be carried up any stairs:   Y/N      (delete where not applicable)

Additional Information: