Email back to: admin@airglideus.com
Tel/Fax: 01202 366710
Forename (s)
Mr Mrs
National Insurance No
Ms
Surname
Contractor
Start Date
Pilot
E Mail Address Agency
Address
Telephone Number inc STD Code *
Mobile Number
Emergency Contact Name :
Were you introduced by a fellow contractor
Yes No
Emergency Contact Number :
If yes, please state their name
Mailing address for remittance slips
UK Bank Details
Name of Bank
A/C Number :
Sort Code :
Address ..........................................................................
.......................................................................................
.......................................................................................
........................................................................................
Type of Account .................................................................
............................................................................................
Name of Account ................................................................
.............................................................................................
Overseas Bank Account Details (if applicable) IBAN No :
I hereby declare all information stated in this document to be accurate
Signed ............................................................ Name ................................................................ Date .......................................*
Please note that if we do not have a contact number for you, this will delay any payments should a problem occur regarding your money