LocalReach Ltd new customer bank details form

LocalReach Ltd new customer bank details form
Business name *
Customer Name *

Title First Name Last Name

Please confirm which advert size, area and quantity you have booked *

	Burnham-on-Sea	Wells	Wedmore, Cheddar, Winscombe, Axbridge	Street & Glastonbury
Full page
Half Page
Quarter page
1/8 page
1/16 page
1/32 page

Duration *

3 Months minimum booking period then ongoing until you notify us otherwise. 6 Months minimum booking period then ongoing until you notify us otherwise 12 months minimum booking period then ongoing until you notify us otherwise

Address *

Street Address
Street Address Line 2
City/Town	County
Postcode	Country

Billing Address (If different to above)

Street Address
Street Address Line 2
City/Town	County
Post Code	Country

Phone Number *
Email *
example@example.com
Account number *
Sort code number *
Rate our service! *
Additional notes, feedback or information
Signature *

Clear
Thank you for booking with LocalReach community magazine!
Would you like to be part of our LocalReach referral scheme? A chance to earn by money by recommending friends, family or other businesses to LocalReach *

Yes please, send me more info! Not intrested
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