Share Offer Application – Energise South Society

Energise South Society Ltd - Registration number 8049

I apply to be a member of and wish to invest the total amount shown below in Energise South Society on the Terms and Conditions of the Offer Document dated 16th September 2019 at the price of £1.00 per Share.

Amount To Invest*

You must invest at least £50 but not more than £30,000.

Please enter the figure without a pound sign.

Please enter a number from 50 to 30000.

Applicant Details

Title*

Title (Mr/Mrs/Ms/other)

Forenames*

Surname*

Address line 1*

Address line 2

Town*

County

Post Code*

Date Of Birth*

DD

MM

YYYY

Email Address

Enter Email Confirm Email

Main phone number*

Alternative phone number

Add your mobile or evening phone number (optional)

Application Type*

Are you applying just for yourself, or as a nominee for a child

Self Only
Nominee for a child

If Applicant is nominee for a child

Child's Forenames

Child's Surname

Child's Date Of Birth*

DD

MM

YYYY

Child's Street Address*

Enter the child's address if different from that given above

Child's address line 2

Child's Town*

Child's County

Child's Post Code*

Payment Details

Payment Type*

If paying by electronic transfer through the banking system please pay into Energise South's bank account quoting your surname and date of birth as a reference.

Account details: account number 65875351, Sort Code 08-92-99.

Your Application Form will not be accepted until payment has been received.

I have paid by bank electronic transfer or BACS to 'Energise South Society Ltd'
I will send a cheque or bankers draft crossed A/c Payee to the value indicated above, payable to 'Energise South Society Ltd'.

I understand that the cheque supporting this application will be presented for payment following receipt and I warrant that it will be paid on first presentation. I have written my address on the back of the cheque.

Share Interest Payments

Energise South Society will pay share interest by electronic transfer via BACS. In order to receive your share interest please provide the following details:

Bank Account Number

Bank Sort Code

Name on account

How did you hear about us?

Energy4All
Friends & Family
Social Media
Other (Please Specify)

Other (Please specify)

Notices by email and documents on our website

To help reduce paper costs (and CO2 emissions), Energise South Society Ltd and Energy4All would like to send you notices and information by email and refer you (by email) to documents posted on the Energise South Society Ltd and Energy4All website. By applying online you are consenting to receiving such notices by email and accessing documents through the website.

Energise South Share Offer Application

Applicant Details

If Applicant is nominee for a child

Payment Details

Share Interest Payments