ESL Biz Club Membership
Order Booking & Confirmation Form
Email address *
CLIENT DETAILS
Date *
MM
/
DD
/
YYYY
Name of Person Placing the Order *
Your answer
Business Trading Name *
Your answer
Address *
Your answer
Town *
Your answer
County *
Your answer
Postcode *
Your answer
Telephone *
Your answer
Mobile *
Your answer
Website Address *
Your answer
ACCOUNTS DETAILS
If different to the details given above
Accounts Contact Name
Your answer
Accounts Telephone
Your answer
Accounts Email Address
Your answer
Business Account Name (If Different from Above)
Your answer
Purchase Order No./Reference
Your answer
Billing Address (If different from above)
Your answer
Billing Address Postcode
Your answer
MEMBERSHIP OPTIONS
Biz Club Membership
PAYMENT METHODS
NB Payment for all Memberships and Advertising must be made IN FULL with this order to be eligible for discounts.

BACS Payment Details: RBS Account: 10167792 Sort Code: 16-21-20

Cheques: Payable to MINX MEDIA LTD

Your Bank Account Name *
Your answer
Please select payment method *
YOUR SOCIAL MEDIA ACCOUNTS
Let us know what your social media accounts are so that we can link up, share and spread the word about your business.
What is your Facebook URL? e.g. fredsbusiness
Your answer
What is your Twitter handle? e.g. @fredsbusiness
Your answer
What is your Instagram Name? e.g. fredsbusiness
Your answer
What is your LinkedIn URL?
Your answer
TERMS & CONDITIONS
I confirm that I am authorised to place this order and that I have read and agree to the Terms & Conditions detailed above *
I subscribe to receiving an ESL Business Newsletter and consent to my email address being used for this purpose
WHAT HAPPENS NOW?
You will be issued with a VAT inclusive invoice
All bookings are accepted subject to our standard terms and conditions
Advertisements either online or in print will not be published until full payment has been received
A copy of your responses will be emailed to the address you provided.
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