Room Hire Account Request Form

Contact name

Organisation
Enter contact name again if applying as an individual

Address

Postcode

Contact email address

Invoice email address
Email where invoices are sent if different from contact email

Phone number

Website

Select the option that best describes your group/organisation/enterpriseNot for profitCommercial enterpriseCommunity Base tenantPostal address customerOther

If you're NOT a Community Base tenant, how do you intend to pay for your bookings?I would like to pay in advance with a debit or credit cardI would like to be invoiced in advanceI am a Community Base tenant

Please read our room hire contract and check the box below to confirm that you agree.I agree to the terms of the Community Base room booking contract

Upload your signature (JPG, PNG or GIF files only)
Uploading a photograph or scan of the signature of the person named above will speed up the contracting process.