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Name *	Surname *
Client of us * Yes: No:	Phone *
Email*	Place of bet handling * Choose bet handling Shop Office Bar Other
Type of business-description*	Address 1 *
Address 2 *	Address 3
Postcode *	Country *
Have you any experience in betting industry?* Yes: No:	How many customers can you find to bet each week (estimate)* Choose customers 0-20 21-50 51-100 101-200 201-1000 +1000
Are you involved in a commercial activity?* If 'yes' please describe below Yes: No:	Do you have broadband access and a pc at the site for processing bets?* Yes: No:
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