Primary Authority Membership Request Form

DETAILS REQUIRED IN ORDER TO ACCESS BENEFITS FROM THE CITY OF LONDON, AS A PRIMARY AUTHORITY TO ACT ON REPTA MEMBERS BEHALF

Organisation Name(Required)

Enter here your trading name.

Licensed Premises Address(Required)

Street Address Town County Post Code Country

Contact Name(Required)

First Last

Work Phone(Required)

Mobile Phone(Required)

Email Address(Required)

Legal Entity Name(Required)

This may be the same as the Trading name, but should be as it appears on Companies House or HMRC documents.

Legal Entity Type(Required)

Sole Trader

Limited Company

Partnership

Other

Legal Entity Number(Required)

Your registered company number with Companies House