Subscription/Licence agreement (Accommodation/Residential address Please print in capitals • Name/s • Title • Home address • Postcode • Country • Email address Telephone/Contact numbers • Home Business UK Mobile Non UK Mobile/Cell phone • Emergency Business address (if different from above) Address for mail to be forwarded to (if different from above) Period of Agreement • from: • to: (Please tick as appropriate) Oxfordshire (Letter post only) 1 Month = £25.00 3 Months = £60.00 6 Months = £100.00 12 Months = £150.00 * NO signed for or registered post/parcels allowed or being on the Electoral Role Wales (Letters and small parcels) 1 Month = £20.00 3 Months = £50.00 6 Months = £88.00 12 Months = £110.00 * Registered and signed for post accepted Gloucestershire (Cotswolds) Letter post only 1 Month = £25.00 3 Months = £60.00 6 Months = £100.00 12 Months = £150.00 * Monthly and new build Plus: £20 postage deposit (kitty) to be topped up if/when needed Additional adults and/or services: Additonal adults joining your valid account (tick if required) Additional adult joining main account holder's account = £20.00 Children 16 years or under = Free Communal telephone service (House telephone number) = £60.00 Please note: If less than 3 months is taken, 1 month deposit required Are you a UK citizen? Yes No Nationality (if non UK) • Occupation (Please tick as appropriate) Employed? Own Business? Business website (if applicable) Retired? Previous occupation (if retired) Optional Family/Friend/Other (Additional contact/emergencies) Name Address Telephone number Mobile Email address I agree to the terms and coditions and that the post/mail received/expected/expecting at/by the residential/accommodation address/the licence/agreement will not be used for fraudulent activites, deception or anything illegal or otherwise of the UK laws • Signed by Licencee: (mark with an X) • Date • Print name • I agree (mark with an X)