Application Form

Let's Do This

Thank you for choosing Blink. We've got the products, partnerships, passion and, above all else, personality. Membership doesn't cost a penny and our application only takes a few minutes to complete.

Fields in bold are mandatory

Your Name:
Your Job Title:
Your Email Address:
Your Telephone Number:
Company Name:
Company Trading Name(s)/Style(s):
+
Postcode:
Find Address
First Line of Address:
Second Line of Address:
Town / City:
County:
Company Email:
Company Telephone Number:
FCA Registration Number:
Companies House Registration Number:
Legal Status:
Authorisation Type:
Can Hold Client Money:
Consumer Credit Act:
Group Structure:
Authorised Signatory:
Authorised Signatory Email:

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Terms and Conditions:
All done, thanks for completing your details, simply read and tick the two boxes underneath and we will be in touch.

The privacy and security of your personal information is really important to Us. Please take a few minutes to read our PRIVACY NOTICE to understand Our views and practices regarding your personal data and how We will treat it. The information you provide on this online application form will be used by Us to process your application. It will also be used to effect business introductions to insurers and other providers of general insurance products and associated services.

This may include undertaking credit checks and seeking references for the purposes of verification, identification and in accordance with Our regulatory requirements which may involve making further enquiries about the business and any individual within the business. Such enquiries may include:

- Credit searches on both the business and individuals
- References from other financial services companies
- Searches of records held at Companies House
- Other records as deemed appropriate for the purpose of this application
- We may share your relevant personal and commercial information with insurers and other providers (who we work with) to effect business introductions for the purposes of agency applications.

Where We effect business introductions please be aware that they have their own privacy policies and We do not accept any responsibility or liability for these policies.
Tick to consent to the information you provide in this application being used in the manner set out above.

Keep in Touch with Blink

We would like to keep in touch and provide you with general updates and information on products and services we can provide access to as well as Our general news updates. Rest assured, we will not bombard you with communications and if you change your mind you can opt-out at any time.

I am happy to receive communications by email

Please show Our PRIVACY NOTICE to anyone else whose personal information you will be providing to Us (such as employees) and ensure that you have obtained their consent prior to disclosing it.
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