Vaxlynx Rental Online Application Form
Vaxlynx Limited 401 Sheldon Heath Road Sheldon Birmingham B26 2UB
What would you like to rent? *
Name *
Your answer
Email *
Your answer
Address *
Your answer
Postcode *
Your answer
Mobile phone number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
How many flights of stairs for the machine to be installed in the property *
Installation fee *
Required
6 month agreement *
Required
Monthly payments *
Required
Affordability *
Available monthly income after expenditure *
What day do you receive payment *
MM
/
DD
/
YYYY
Reference 1 : Name, Address and Mobile number *
Your answer
Reference 2 : Name, Address and Mobile number *
Your answer
Submit
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