Fee payable

There is a non-refundable fee of £180 which must be paid when submitting this form. Please have your card details ready so you can pay for your application.

Address of premises to be licensed

Your appointment

Contact details

Contact address

Contact details

I understand that:

• You are unable to give any guarantees about the decision of my application
• Any advice given will be based on best practice and knowledge of the local area
• The fee is non-refundable
• The I am responsible for advertising my application
• Information disclosed as part of my application may be passed on to other departments within the authority or other agencies and bodies to process my application or to prevent or detect fraud or crime

Data protection

The information you have provided on this form will be used to deal your request by the relevant department. We may pass your details on to contracted third party service providers. We will store a copy of your completed request as a backup for 12 months.

If you would like to know more about how we use your information and how you can exercise your information rights please see our privacy notice.