If you would like to authorise us to distrain
please submit the form below after filling in all the required
fields marked with a *.
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| To:- Bristow & Sutor of Bartleet Road, Washford, Redditch, Worcestershire, B98 0FL
or whosoever they may authorise holding a Bailiff's Certificate.
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| We (or I) do hereby authorise you
to seize and distrain the goods, chattels and effects, in and upon the
Office, Warehouse, House, Land and Premises, in the tenure and occupation of:
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| Tennant Name: *
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| Tennant Address: * |
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| Post Code:
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| for the sum of: * (the full amount you want us to collect) |
£
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| being the rent due on: * (insert date on which the latest sum of rent was due) |
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| calculated at: *
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£ per
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| and to proceed for the recovery of the said rent as the law directs and we/I do hereby indemnify you against any proceeding or proceedings that may be instituted against you, as well as against all fees or charges which you may incur or be liable to pay by executing this warrant, and do hereby undertake not to hold you accountable for any goods forcibly or clandestinely removed. |
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| I acknowledge that I am bound by your Terms & Conditions that have been supplied to me or are available for inspection. |
| Date of Instruction: * |
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| Payment Timeframe: * |
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| Special Instructions: |
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| Name of Landlord / Agent: * |
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| Landlord / Agent Address: * |
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| Landlord / Agent Post Code:
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| Contact
Email: * |
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| Contact
Tel: * |
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| Name of Landlord if Different to Above: |
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| Landlord's Address if Different to Above: |
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| Post Code:
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| Specify Tennancy: * |
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| Is there a Lease or Agreement? * |
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| If discussed with B&S, person spoken to: |
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