CHANGE OF PROPRIETOR FORM

If you are leaving your premises, please complete this form. You may be entitled to a refund.

Title *	Dr. Miss Mr Mrs Ms Other Revd. Other	Required items appear in bold with an asterisk.
Forename *
Surname *
Please enter at least one * of the following so we can contact you.
Email
Telephone		Please enter your full telephone/fax number including STD code.
Fax
If you are an existing PRS customer, please enter your customer reference number, and the business it relates to. e.g. 123456/7P, The Red Lion
Customer reference number
Business name
Please enter the date you will be leaving (or have left) the premises
Leaving date *
If you know the new proprietors name, please enter it below
New proprietor's name
If you are leaving to go to another premises, please enter the details of the premises below
Full business name
Business address
Postcode
Country	United Kingdom *
Web site address
Email address		Please enter your full telephone/fax number including STD code.
Telephone number
Fax number
Type of premises (e.g. pub/shop/hotel etc.)
Please enter the date you will be taking over (or have taken over) the premises
Starting date
Please give a brief description of the (intended) music use at your new premises e.g. radio, TV, disco, live performers, etc. *
When would it be most convenient for us to contact you to discuss your requirements (our normal opening hours are Monday to Friday 8.30am to 5.00pm (GMT) but we will endeavour to contact you outside these hours if you wish) *