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Address

Post Code

Telephone Number

Email

PAYMENT FREQUENCY

Payment Card
Application Form

Full Name

(you will need to enter your email address to receive
receipt of your application)

PERSONAL DETAILS

Annually (due by 1st May each year)

Half Yearly (due on 1st May and 1st September each year)

10 Monthly (due on 1st of each month from April-January each year)

Title

MISS MR MRS MS OTHER

Council Tax Account Number

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