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Personal Information - Main Contact

First Name *

Surname *

Phone Number *

Email *

Company Information

Company Name *

Company Email Address *

Company Phone Number *

Company FCA Number *

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Company Address Line 1 *

Company Address Line 2

Company Address Line 3

Company Address Line 4

Company Postcode *

Company regulatory status

Directly Authorised

Appointed Representative

Principal Name

Principal FCA Number

Do you have the permission of your principal to deal with 3XD?

Yes

What level of service do you provide?

Advised

Non-Advised

How many mortgages do you write each month?

How many Home Insurance policies do you write each month?

How many Buy-to-Let Insurance policies do you write each month?

How many Mortgage Payment Protection policies do you write each month?

How many insurers do you use for Home/Landlords Insurance?

How many insurers do you use for Mortgage Payment Protection?

Services From 3XD

Would you like 3XD to prepare your statement of demands and needs?

Yes

Would you like 3XD to inform you when a customer cancels?

Yes

Would you like 3XD to email you with regular updates to products and services?

Yes

Bank Details

These details are collected solely for the purposes of paying you commission.

Bank Sort Code *

Bank Account Number *

Bank Account Holder's Name *

Bank Name *

Preferred commission type

Initial Indemnity

Monthly

Terms of Business Agreement

Please read the Terms of Business Agreement by clicking here.

I accept the Terms of Business Agreement

To speak with a member of our team, please call 0333 242 5111.

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