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DSG REFERENCE
BUSINESS INFORMATION
REPORT (BIR)
Your Company Name:
Company Name:
Name Trading As
(if applicable):
Company Number:
Postcode of
Demise Address:
Full Name of Proprietor 1:
Home Postcode of Proprietor 1:
Your
Address:
Your Reference:
Your Phone:
Your Fax:
Invoices Payable to:
CORPORATE ENTITIES NON-CORPORATE ENTITIES
CLIENT DETAILS
Debt Squared Group, Carnouse House, Kelvin Close, Birchwood, Warrington, WA3 7PB
Tel: 0800 002 9049 Fax: 0845 241 5006 Web: www.debtsquared.com Email: trac[email protected]om
Debt Squared Group Limited. Registered in England and Wales.
Reg. oce: St. Crispin House, St. Crispin Way, Haslingden, Rossendale, Lancashire, BB4 4PW
Company Reg No. 6729253 - VAT No. 978 3663 59
Charges: This service is charged at the rate of £15 + VAT per instrucon unless otherwise quoted.
Invoices are to be paid within 30 days.
*This form must be signed
Signature of Person Authorising Instrucon
Print Name:
Date:
Surveyor Name
Credit Control Name
Company Name
Telephone Number
By authorising this instrucon we conrm that we have read and accept the
Standard Terms and Condions of service.
Postcode of Registered Address:
Postcode of Trading Address:
Full Name of Proprietor 2:
Home Postcode of Proprietor 2:
Please complete as many details as possible.
Business Name:
Please complete as many details as possible.