Broadcast Services Account Application

Type of Organisation applying for account*

Company Name*

Partnership Trading name*

Registered Number*

Name*

Charity Name*

Charity Number*

Government Agency or Local Authority*

Educational Establishment Name*

Is your organisation VAT Registered?*

YesNo

VAT Registration Number*

Registered office address*

Street Address

Street Address Line 2

CityCounty / State

Postal / Zip CodeCountry

Trading address is the same as Registered Office address

YesNo

Trading & Invoice Address

Street Address

Street Address Line 2

CityCounty / State

Postal / Zip CodeCountry

Sole Traders & Partnerships please provide proof of address by uploading a recent utility bill*

Upload a File

Landline Phone Number*

Mobile Phone Number*

Fax Number

Contact email*

email address for invoicing if different from above

My organisation requires order numbers on invoices*

Please note that whilst we will always quote an order number if given at the time of booking, we will send an invoice without an order number if the number is not received within 7 days of the booking start date. We will not enter into any discussion regarding missing order numbers on invoices where the number was not given to us by the above deadline.

Website

Contact Name*

Charity Number*

Credit limit requested*

We will normally ask for a card or BACS payment on the first occasion & will then move your account to 30 day terms. Your credit limit will be as suggested by Credit Safe Ltd.

How did hear about us?*

Bank Name*

Account Name*

Sort Code*

Account Number*

Please select an option:*

I have my own insurance for hired in video equipment and will complete the fields below and upload my insurance certificate.
Please ensure that the certificate specifically shows the amount of Insurance cover for hired in equipment.

Note that Public or Employer liability policies DO NOT provide insurance for hired in equipment.

I understand and agree that in the event of a loss or damage that results in a claim, I or my company or organisation will be responsible for the full replacement value of the equipment whether or not a valid insurance policy is in place.

It is the clients responsibility to ensure that sufficient cover is in place to fully insure the equipment being hired. Replacement must be on a new for old basis and continuing hire charges will be incurred until the equipment is replaced.

I wish Broadcast Services to insure the equipment at a cost to me of 10% of the total hire fee, subject to a minimum fee of £25. A £250 excess will apply. Please read and understand the conditions attached to this form particularly regarding equipment left unattended in vehicles as failure to comply with these conditions will invalidate the insurance.

Insurance Policy number*

Insurance Policy Company*

Amount of Cover for hired in equipment as stated on Hired in Equipment Policy Document £*

Policy Expiry Date*

Insurance Policy Certificate upload*

Upload a File

Reference 1 Company name*

Reference 1 Contact name*

Reference 1 Address*

Reference 1 Telephone*

Reference 1 email address*

Reference 2 Company name*

Reference 2 Contact name*

Reference 2 address*

Reference 2 Telephone*

Reference 2 email address*

Director 1 name and address*

Director 2 name and address

Director 3 name and address

Partner or proprietor 1 name and address*

Partner or proprietor 2 name and address

Partner or proprietor 3 name and address

Trustee 1 name and address*

Trustee 2 name and address

Trustee 3 name and address

Broadcast Services Ltd

Insurance Options

Trade References

Reference 1

Reference 2

Declaration