Mr Mrs Miss Ms     Other:               Date:

First Name:     Last Name:

(Business only: Company or Trading Name:    

(Business only: Position in Business:  Number of years trading: 

Address:

Postal Town/City Post/Zip Code:

County (UK)/State (US)/ Province/Region

Country:   Mobile phone :

Telephone:   Fax:

Email address: 

Please indicate the type of Card you require:     Personal     Business     

(Please refer to the “Credit Cards” page on our website for full details of the above.)

Personal:   Single fee of £300 to include the bank account and as many cards as you require.

Business:   Single fee of £450 to include the bank account and as many cards as you require.

Payment should be made by a UK cheque, postal or money order and payable to  “Jayga  Ltd” or if urgent or you are outside the UK, please email us to request our bank details for a wire transfer.

Statement

I/We the undersigned request Jayga  Ltd to arrange an introduction to a financial institution for the opening of a Bank account with associated Credit Card facilities referred to above.  I/We agree to pay the above fees which are refundable in full if an application is unsuccessful and the service not provided.   I/We understand that Jayga Ltd is acting as an intermediary, providing information and referrals only and does not offer credit, deposit or banking facilities nor any guarantee of the credit card company or its performance.  Any deposits which may be required to open the account will be payable directly to the appropriate financial institution. 

Signed : ______________________________________________  Date:  ____________________________

(1) From time to time we may wish to contact you by email, telephone or post about our new services, products or special offers which may be of interest to you.   If you do not wish to be contacted in this way, please check box

(2) We may also wish to contact you occasionally about services, special offers and products that third parties are offering and that we believe may be of interest to you.  If you do not wish to be contacted for marketing purposes, please check box

It would be helpful to us to know how clients heard about us and we should be grateful if you would kindly indicate if this was by  (a) searching the internet ,   (b) press advertisement  ,  or (c) recommendation, in which case please state from whom