Distribution of free printed matter (leaflets) consent form

Use this form if you would like to distribute free printed items such as leaflets.

Once you have completed the form you will be taken to our payments page to make the appropriate payment.
Application details
1. Applicant type
  
  Limited Company
  
  Sole Trader
  
  Partnership
2. Applicant details
  1. Applicant / Company name
  2. Address line 1
  3. Address line 2 (optional)
  4. Town/city
  5. Postcode
  6. Telephone number
  7. Email address
  8. Mobile number (optional)
3. Is the correspondence address different to the address above?
  
  Yes
  
  No
4. Correspondence Address
  1. Name (optional)
  2. Address line 1 (optional)
  3. Address line 2 (optional)
  4. Town (optional)
  5. Postcode (optional)
  6. Email address (optional)
5. Convictions and Fixed Penalty Notices
  1. Has the Applicant / Company / Partnership received or paid any fixed penalty notices within the last 5 years relating to the distribution of free literature?
    
    Yes
    
    No
  2. Please provide details, including dates, below. (optional)
  3. Has the Applicant / Company / Partnership had any convictions within the last 5 years relating to the distribution of free literature?
    
    Yes
    
    No
  4. Please provide details, including dates, below. (optional)
6. Name of the person completing this form
7. Commencement date for consent
  
  Day
  
  Month
  
  Year
Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).

Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .

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Distribution of free printed matter (leaflets) consent form