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Introducer Name
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Address
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Postcode
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Head Office Address (if
different)
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Head Office Postcode (if
different)
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Telephone Number
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Mobile Telephone Number
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E-mail Address
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Are you...
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If your an Appointed
Representative, please provide the following
details...
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FSA Number |
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Network Name
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Network FSA Number
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I would like to receive
commission by...
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If you would prefer
to be paid by Cheque, who should the cheque
be made payable to...
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Payee
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If you would prefer
a Bank Transfer, please provide the following
account details...
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Account Name
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Sort Code
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Account Number
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Please provide a password to register
for Case Tracking. |
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I can confirm the the
information provided above is correct
and that I am authorised to complete forms
of this nature. If any of the above information
should change in the future I will ensure
that W&B Mortgage Solutions are notified
of these changes. I can confirm that I
am responsible for any advice given to
clients in respect of applications processed
by W&B Mortgage Solutions and that
W&B Mortgage Solutions cannot be held
responsible for any advice given by myself.
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Please initial the box
to confirm
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If you would like to be
contacted by W&B Mortgage Solutions
for more information please tick the box...
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