Authorisation Form

AUTHORISATION FORM

Customer 1

Title

Customer 1 First Name

Customer 1 Last Name

Phone/Mobile

Customer 2

Title

First Name

Last Name

Phone/Mobile

Tenancy Address

Address Line 1

Address Line 2

Town / City

County

Post Code

I authorise you to supply any relevant information that you may hold about me and any accounts that I may have with you. *

I confirm that Shropshire Town and Rural Housing are assisting me in the conduct of my financial affairs and I authorise them to act on my behalf. *

I have read and agree to the Privacy Policy *

Signature

Sign Here

Signature

Sign Here

Shropshire Towns and Rural Living Limited is Registered in England and Wales, Registered Society Number: AB12345678. Registered Office Address: Ptarmigan House, Shrewsbury Business Park, Shrewsbury SY2 6LG. We are Registered with the ICO under Registration Number: 1234567. Shropshire Towns and Rural Living is Authorised and Regulated by the Financial Conduct Authority, Firm Registration Number: 1234567

2026

Shropshire Towns and Rural Housing.

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