About Us The Product Tariff Application Form Intrum.co.uk Name (authorised signatory) * Position * Registered Company Name (the client) * Registered Company Address * Company Registration No. * Telephone * Fax Email * Preferred Contact Name/Tel (if different from authorised signatory above) Type Of Company Other Limited Company Partnership Sole Trader *   If other please specify Nature of Business * Country of incorporation England Scotland I confirm that I have read and agree to the Terms & Conditions of the Agreement Intrum Justitia may contact you from time to time about other services. If you do not want to receive this information please tick this box    * denotes a required field Intrum Justitia reserves the right to refuse any application.