LocalReach Ltd new customer Direct Debit form
Eazycollect part of AccessPay Suite.
Business name
*
Customer Name
*
Mr.
Mrs.
Miss
Ms.
Title
First Name
Last Name
Email
*
example@example.com
Choose which magazine areas and advert size
*
Rows
Back Page
Full Page
1/2 Page
1/4 Page
1/8 Page
1/16 Page
Taunton/TA1
Bridgwater/TA6
Burnham-on-Sea & Highbridge/TA8/TA9
Somerton & Langport/TA10/TA11
Wellington/TA21
Minehead/TA24
Portishead/BS20
Clevedon/BS21
Worle/BS22
Weston-super-Mare/BS23
Weston-super-Mare/BS24
Wedmore,Winscombe,Axbridge,Banwell,Cheddar/BS29,BS28,BS27,BS26,BS25
Chew Valley/BS40
Nailsea & Backwell/BS48
Yatton & Congresbury/BS49
Shepton Mallet/BA4
Wells/BA5
Street & Glastonbury/BA6/BA16
Frome/BA11
Yeovil/BA20/BA21
Do you require a local number in your advert? They are included in the price and we highly recommend them. You don't then need to add your home number in your advert as these VOIP numbers point seamlessly to your mobile. 01275, 01934, 01458, 01749, 01278, 01935, 01823, 01643, 01373.
*
YES
NO
Duration
*
You are signing to advertise for a minimum of 3 Months minimum booking period then ongoing until you notify us otherwise. Payment will be taken via 3rd party company AccessPaySuite and will appear on your bank statement as Eazycollect. You will get full written confirmation by post but any problems emails us in the first instance accounts@localreach.co.uk
Address
*
Street Address
Street Address Line 2
City/Town
County
Postcode
Billing Address (If different to above)
Street Address
Street Address Line 2
City/Town
County
Post Code
Phone Number
*
Bank details
Name on bank account
*
Account number
*
Sort code number
*
Additional notes, feedback or information
Signature
*
Thank you for booking with LocalReach Community Magazines.
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