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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, Carnouse 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. oce: 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 instrucon unless otherwise quoted.
Invoices are to be paid within 30 days.
*This form must be signed
Signature of Person Authorising Instrucon
Print Name:
Date:
Surveyor Name
Credit Control Name
Company Name
Telephone Number
By authorising this instrucon we conrm that we have read and accept the
Standard Terms and Condions 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.
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