FreedomCAM Ltd - New Connection Request

FreedomCAM Ltd - New Connection Request

This form should only be used when a new FreedomCAM connection is required. If you cannot complete this form, or require assistance please contact 08456 430 832. The information entered into this form is transmitted over a secure connection and within the EU.

Basic Information
Date of Submission*

MonthDayYearHourMinutesAM/PM Option
Your Name*

First NameLast Name
Company Name*
Your E-Mail Address*

Site Information
Site Name*
Site Telephone No*

Area CodePhone Number
Site Address*

Street Address

Street Address Line 2

CityRegion

Postal CodeCountry
Police Region*

Site Opening/Closing Times
Site Opens (Mon)*

:HourMinutesAM/PM Option
Site Closes (Mon)*

:HourMinutesAM/PM Option
Site Opens (Tue)*

:HourMinutesAM/PM Option
Site Closes (Tue)*

:HourMinutesAM/PM Option
Site Opens (Wed)*

:HourMinutesAM/PM Option
Site Closes (Wed)*

:HourMinutesAM/PM Option
Site Opens (Thu)*

:HourMinutesAM/PM Option
Site Closes (Thu)*

:HourMinutesAM/PM Option
Site Opens (Fri)*

:HourMinutesAM/PM Option
Site Closes (Fri)*

:HourMinutesAM/PM Option
Site Opens (Sat)*

:HourMinutesAM/PM Option
Site Closes (Sat)*

:HourMinutesAM/PM Option
Site Opens (Sun)*

:HourMinutesAM/PM Option
Site Closes (Sun)*

:HourMinutesAM/PM Option
Site Opens (Bank Holidays)*

:HourMinutesAM/PM Option
Site Closes (Bank Holidays)*

:HourMinutesAM/PM Option

Key-Holder Information
Key-Holder 1 Name*

First NameLast Name
Key-Holder 1 Email*
Key-Holder 1 Tel No*

Area CodePhone Number
Key-Holder 1 Confirmation Word
Key-Holder 2 Name*

First NameLast Name
Key-Holder 2 Email*
Key-Holder 2 Tel No*

Area CodePhone Number
Key-Holder 2 Confirmation Word
Key-Holder 3 Name

First NameLast Name
Key-Holder 3 Email
Key-Holder 3 Tel No

Area CodePhone Number
Key-Holder 3 Confirmation Word

Declaration

By ticking the below box and submitting the below form, you confirm that the information contained within this form is correct (so far as you are aware). We cannot accept responsibility for information which has been submitted incorrectly, which results in any Key-Holder/Police/other Authority being either prevented or delayed.
Notes

Use this area to add any additional information which you think is necessary.0/200
Signature*
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