LocalReach Ltd new customer Direct Debit form
Eazycollect part of AccessPay Suite.
Business name
*
Customer Name
*
Mr.
Mrs.
Miss
Ms.
Title
First Name
Last Name
Email
*
example@example.com
Choose which magazines you would like to advertise in
*
Full Back page
Inside Full page
Inside 1/2 page
Inside 1/4 page
Inside 1/8 page
Inside 1/16 page
Bridgwater/TA6 - 24,949 copies
Burnham-on-Sea/TA9 & TA8 - 15,120 copies
Weston-super-Mare/BS23 - 17,307 copies
Worle/BS22 - 17,651 copies
Clevedon/BS21- 11,675 copies
Portishead/BS20 - 15,686 copies
Glastonbury & Street/BA6 & BA16 - 13,593 copies
Wedmore, Cheddar, Winscombe, Axbridge/BS28, BS27, BS26, BS25 - 11,162 copies
Wells/BA5 - 10,114 copies
Somerton & Langport/TA11 & TA10 - 10,048 copies
Shepton Mallet/BA4 - 8,944 copies
Duration
*
You are signing to advertise for a minimum of 3 Months minimum booking period then ongoing until you notify us otherwise. Payment will be taken via 3rd party company AccessPaySuite and will appear on your bank statement as Eazycollect. You will get full written confirmation by post but any problems emails us in the first instance accounts@localreach.co.uk
Address
*
Street Address
Street Address Line 2
City/Town
County
Postcode
Billing Address (If different to above)
Street Address
Street Address Line 2
City/Town
County
Post Code
Phone Number
*
Bank details
Name on bank account
*
Account number
*
Sort code number
*
Additional notes, feedback or information
Signature
*
Thank you for booking with LocalReach Community Magazines.
Continue
Continue
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