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Change of Proprietor Form

If you are leaving your premises, please complete this form. You may be entitled to a refund.

Required items appear in bold with an asterisk. *
Title *
Forename *
Surname *

Please enter at least one * of the following so we can contact you.
(Please enter your full telephone/fax number including STD code.)
Email address

If you are an existing PRS for Music customer, please enter your customer reference number, and the business it relates to. e.g. 123456/7P, The Red Lion
Customer reference number
Business name

Please enter the date you will be leaving (or have left) the premises
Leaving date *(dd/mm/yyyy)

If you know the new proprietors name, please enter it below
New proprietor's name

If you are leaving to go to another premises, please enter the details of the premises below :
Full business name
Address line 1
Address line 2
Address line 3
United Kingdom *
Web site address
Email address
Please enter your full telephone/fax number including STD code.
Telephone number
Fax number
Type of premises (e.g. pub/shop/hotel etc.)
Please enter the date you will be taking over (or have taken over) the premises
Starting date (dd/mm/yyyy)

Please give a brief description of the (intended) music use at your new premises e.g. radio, TV, disco, live performers, etc. *
When would it be most convenient for us to contact you to discuss your requirements (our normal opening hours are Monday to Friday 8.30am to 5.00pm (GMT) but we will endeavour to contact you outside these hours if you wish) *
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