Certificates & labels order online

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Form F-11 V2.4

Fields in bold and marked with an asterisk ‘*’ are required and must be entered.

Your details

These details are used for security and your protection.

Account number *

Title * (Mr./Mrs. etc.)

First name(s) *

Last name *

Company/organisation (leave blank if not applicable)

Country *

Address *

State *

Postal/ZIP code *(leave blank if not applicable)

Telephone

Email address

Details of the work

Registration number *

Title of work *

Required items

Number of certificates @ £2.50 each

Number of label sheets @ £2.50 each

Declaration

I have read and accept the terms and conditions.*

I hereby accept the terms and conditions and request that registered notice labels are issued for the work detailed above, and sent to the address specified on this form.

Signed(Account holder/Authorised agent)

Date

Applicants under 18 should also obtain signature from a parent or guardian:
Name of Parent/Guardian
Signature

Payment details

Paying by cheque of postal order

Please make cheques/postal orders/international money orders for UK Pounds Sterling (GBP), and made payable to ‘Copyright Witness Ltd’.

Paying by credit/debit card

Payment method (tick one)	Visa Credit Mastercard Visa Debit UK Maestro American Express
Cardholder’s name (name exactly as it appears on the card)
Card number
Valid from date - Month/Year (if shown)
Expiry date - Month/Year
Issue number (if it appears on your card, otherwise leave blank)
Security code (3 or 4 digit code, normally found on signature strip)
Company/organisation (leave blank if not applicable)
Cardholder’s address Postal address including postal/ZIP code
Cardholder’s country
Telephone
Email address
We recommend that an email address or telephone number is given, in case of any problem regarding payment.
Cardholder’s signature

certlabels-sendto

4 Tavistock Avenue

Didcot

Oxfordshire

OX11 8NA

United Kingdom

The prices quoted on this form are valid until the end of February 2025. After this time please visit our web site at www.copyrightwitness.com to obtain a valid application form.

This form uses JavaScript, but it appears that your browser either does not support JavaScript or you have turned JavaScript off. To proceed without JavaScript, please use the PDF form

which includes full instructions. Alternatively, you may try enabling JavaScript and restarting your browser.