Name *

First Name

Last Name

Invoice Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you like your address published *

e.g if you have a shop or studio

No, please keep our address private

Yes, please publish our address with a map

Phone *

(###)

###

####

Would you like your phone number published? *

Choose your privacy preference

Yes, please add my phone number to my public page

No, please keep my number hidden

Public Liability Insurance *

We have up to date Public Liability Insurance covering us away from our normal place of work and can produce our insurance document upon request

Do you hold all necessary licence and/or certificates to trade in your industry? *

e.g. alcohol licence, vehicle licence

Yes

No

Are all the images on your website of your own work? *

Yes

No

A mixture of my work and stock images, but stock is clearly labelled to avoid misrepresentation

Do you have a clear cancellation policy? *

Yes

No

Do you have any outstanding legal actions against you from customers/suppliers? *

Yes

No

Can you provide 3 references if required? *

Ideally these should be a venue, another supplier and a customer

Yes

No

Image & Content Indemnity *

* I agree to fully indemnify Buckinghams Media against any claims for copyright or other infringement resulting from the use of content or images I submit to them for use online or in print. Furthermore I confirm have the express written permission of the copyright holders AND the people featured in the images, to use and share the images publicly in print, online and social media.

Data *

I agree to allow Buckinghams Media to store and process my personal data

Notifications *

I give my consent to receive future notifications from Buckinghams Media

Declaration *

I declare the information I have provided is true complete and accurate