BLAGG & JOHNSON LIMITED
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Newark Business Park, Brunel Drive, Newark, Notts NG24 2EG


Authorisation to allow your Bank to supply a credit reference.

This form should be completed in full and signed by an authorised cheque signatory. Please complete
all sections, sign and return by post as banks will not accept faxed copies, photo copies or e-mail copies.

We hereby given permission for our Bank to supply status reports in respect of this company
to Blagg & Johnson Limited at any time.

Company Name :
Name of Bank :
Branch

Branch Address :
Sort Code :
Account No :


Signed.............................................                     Position ............................................

(Authorised cheque signatory)