Business Name* (customer-facing name)

Business Address* (customer-facing address)

Registered Company OR Sole Trader Information

Company Name* (as seen on Companies House) / Sole Trader Name*

Company Number* (if not applicable, please put 'N/A')

Company Address Line 1*

Company Address Line 2 (optional)

Company Address Line 3 (optional)

First Name*

Last Name*

Email*

Phone Number*