ESL Biz Club Membership
Order Booking & Confirmation Form
Email address *
CLIENT DETAILS
Date *
MM
/
DD
/
YYYY
Name of Person Placing the Order *
Business Trading Name *
Address *
Town *
County *
Postcode *
Telephone *
Mobile *
Website Address *
ACCOUNTS DETAILS
If different to the details given above
Accounts Contact Name
Accounts Telephone
Accounts Email Address
Business Account Name (If Different from Above)
Purchase Order No./Reference
Billing Address (If different from above)
Billing Address Postcode
MEMBERSHIP OPTIONS
Biz Club Membership
Clear selection
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 *
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
What is your Twitter handle? e.g. @fredsbusiness
What is your Instagram Name? e.g. fredsbusiness
What is your LinkedIn URL?
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 *
ESL Business Newsletter
Each month we will stay in touch with you via our electronic business newsletter, it is a great way of communicating with you and sharing the latest news, updates, opportunities for promotion, journalist visits, shows and business offers. If you would like to stay connected and consent to receiving our newsletter please click YES below. (Please note that your details will only be 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Advertisements either online or in print will not be published until full payment has been received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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