Membership
application
form

Complete the whole form if you can, but YOU MUST COMPLETE ALL AREAS OF THE FORM MARKED WITH * before we can accept your application.

Your details
Title *
First Name *
Middle Name
Family Name *
Daytime Telephone no.
Evening Telephone no.
Mobile Telephone no.
E-mail *
Please ensure this is an email address you will be able to check regularly for contract and payment information.
Address (house and street) *
City / Town *
County *
Postcode *
Visa information
UK National (visa not required)
Type of work visa
Visa expiry date
Agency details
Consultant name
Agency name
Address (number and street)
City / Town
County
Postcode
Agency Telephone no.
Agency Fax no.
Contract details
Start Date
Contract length
Normal hourly rate
Overtime hourly rate
Weekend hourly rate
Hours per week
The fequency of payments is dependent on what is specified in your agency contract.
Bank / Building Society Details
Name of bank / building society
Account name
Sort code
Account number
B.Soc reference number
Branch address	?
Where did you hear about BBuffalo?
Please tell us where you heard about BBuffalo. If a friend or agency consultant recommended us then please tell us their name (and Agency Name if applicable).	?

Mortgages, pensions and investments for the professional contractor.

Have one of our advisors call you back.

BBuffalo Umbrella Company