1g. Please state the local government area in which the premises are situated (see guidance note on p4 where applicable please select Scotland’). – ‘outwith CONTACT DETAILS 1h. Please provide details about the individual that we may contact about the application (see guidance note on p5) Name: Address: Postcode: Email Address: Telephone No: Position/Designation: 1i. Please provide details of the contact and billing address for invoices to be sent (see guidance note on p5) Name: Address: Postcode: Telephone No: Email Address: Position/Designation: SEPA account number (if REMITTANCE INFORMATION Please provide payment details for the application (see guidance note on p5) Please ensure you submit the correct fee for your application. This fee is reviewed every year. For latest fees please consult the latest on the SEPA website ( and search for schemes and summary charging ‘charging booklets’) or contact your local SEPA office. IMPORTANT! When paying by BACS or direct transfer you MUST submit remittance advice or Sort Code 83-34-00 proof of payment with your application form. If BACS this is not received the application will be deemed invalid and returned to you, as SEPA A/C Number 00137187 is unable to process your application without this. Payment is accepted by all major credit/debit cards. Please include payment contact details below so that we can take payment securely Credit/Debit Card Name Tel: Cheque Made payable to and must be included with a printed application form “SEPA” Amount payable £ Reason for non-payment: DECLARATION Please read the declaration and complete the boxes below (see guidance note on p5)
1g. Please state the local government area in which the premises are situated (see guidance note on p4 – where applicable please select ‘outwith Scotland’). CONTACT DETAILS 1h. Please provide details about the individual that we may contact about the application (see guidance note on p5) Name: Address: Postcode: Email Address: Telephone No: Position/Designation: 1i. Please provide details of the contact and billing address for invoices to be sent (see guidance note on p5) Name: Address: Postcode: Telephone No: Email Address: Position/Designation: SEPA account number (if REMITTANCE INFORMATION Please provide payment details for the application (see guidance note on p5) Please ensure you submit the correct fee for your application. This fee is reviewed every year. For latest fees please consult the latest on the SEPA website ( and search for ‘charging schemes and summary charging booklets’) or contact your local SEPA office. BACS Sort Code 83-34-00 IMPORTANT! When paying by BACS or direct transfer you MUST submit remittance advice or proof of payment with your application form. If this is not received the application will be deemed invalid and returned to you, as SEPA is unable to process your application without this. A/C Number 00137187 Credit/Debit Card Payment is accepted by all major credit/debit cards. Please include payment contact details below so that we can take payment securely Name Tel: Cheque Made payable to “SEPA” and must be included with a printed application form Amount payable £ Reason for non-payment: DECLARATION Please read the declaration and complete the boxes below (see guidance note on p5)
easr_permit_modular_application_form_section_1a.docx