Contract Terms and Conditions

Flight Delay Claims Team (E.Asthampton Ltd, Trading as Flight Delay Claims Team), hereinafter referred to as Flight Delay Claims Team.

1.0 Course of procedure
1.1 Flight Delay Claims Team will assert your claim for compensation vis-a-vis the operating airline, solely depending on success, based on Regulation No. 261/2004 of the European Parliament and the European Council of 11th February 2004, the Regulation On Air Passenger Rights, US Code of Federal Regulations and The Montreal Convention regarding rules for airline passengers’ compensation and benefits in the cases of failure to fly passengers and flight cancellations or long flights delay (hereinafter referred to as Airline Passenger Rights Regulation).
1.2 No win No fee: subject to these terms and conditions, if you lose, we will not charge you anything for the cost of our time. No risk to you.
1.3 “Win” means you are awarded, or an opponent agrees to pay you at least damages or compensation in connection with your claim. “Lose” means you do not recover any damages in respect to your claim, but you have adhered to all of our requirements and terms and conditions.
1.4 Flight destination within the EU
€250 compensation for a delayed flight up to 1,500km delay for over 3 hours.
€400 compensation for a delayed flight over 1,500km delay for over 3 hours.
1.5 Flight destination outside the EU
€250 compensation for a delayed flight up to 1,500km delay for over 3 hours.
€400 compensation for a delayed flight over 1,500km up to 3,500km delay for over 3 hours.
€300 compensation for a delayed flight over 3,500km delay for over 3 hours but less than 4 hours. €600 compensation for a delayed flight over 3,500km delay for over 4 hours.
1.6 If you decide to instruct us our charge for our work is calculated at 25% +VAT of your compensation, this is referred to as our Service Fee. In addition there is a fee of £20 plus VAT for each passenger on the claim. Should we need to pass your case to one of our panel solicitors, you may incur an additional charge of 15% + VAT of your compensation to contribute towards these legal costs.This is referred to as the Legal Action Fee. Our charge is payable when your case is successful. This is subject to these terms and conditions. Unlike some other firms, we won’t charge you an initial set up fee to open your case.
1.7 Towards this goal, Flight Delay Claims Team gives you the option to enter your flight data through the web form. Flight Delay Claims Team will conduct an extensive online data bank research on the flight. If our system considers the pursuit of your claim to be sufficiently promising, we shall proceed. Please note that the result of the review does not include any of the binding statement on the actual chance of a successful enforcement of your claim. You have the option of instructing us by entering your personal data, and then forming a contract with ourselves by signing the assignment form / letter of authority.
1.8 If the airline fails to pay within the deadline allotted by us or fails to make an appropriate offer, we will refer the case to our contract solicitors for the purpose of enforcing the claim in court. If this is the case the firm of solicitors may be in touch via email with you directly. And the legal action fee may be charged as described in 1.6.
1.9 You agree to your data being forwarded. In so far as the airline provides reasons that would constitute extraordinary circumstances, and provided our research confirms this result, we will terminate any further action and we will inform you accordingly; no costs will be charged to you.
1.10 It is at the discretion of Flight Delay Claims Team as to whether to pass your case to a Panel Solicitor, and the appropriate timing to do so, if it is deemed necessary. This decision will be based on our knowledge and expertise relating to the industry and will be judged on an individual basis. This decision may be taken without consultation or

notice to the Claimant.
1.11a If the Panel Solicitors come to the conclusion that the probability of successfully enforcing the claim is sufficiently high, they will arrange the legal enforcement for you. In such a case, you authorise us to provide the Panel Solicitors access to any and all data submitted by you and you authorise the Panel Solicitors to forward information on the legal proceedings to us. Please note that in many countries, due to the processing time of the courts, it can take a substantial amount of time to enforce a claim in court. Unfortunately, this means that we have no influence on how fast your claim can be enforced.If a further assignment form or letter of authority or any other document must be submitted to the court as an original document, you agree to sign and send the relevant document to our contract solicitors, or ourselves, without delay.
1.11b If the Panel Solicitors come to the conclusion that the probability of successfully enforcing the claim is not sufficiently high, we will inform you about this conclusion and Flight Delay Claims Team will refrain from any further activities. The collection order shall end with that notification to you. You will receive a brief email outlining the reasons your claim cannot be successfully enforced. In such a case, you will not be charged any costs, nor will you need to attend court.
1.12 Due to “Care only” claims being uneconomic for us to pursue, unfortunately we must also reserve the right to cease acting for you if an Airline raises an Exceptional Circumstances defence under article 5(3) of EC Regulation 261/2004 (Flight compensation/ regulation-261-2004), notwithstanding that you must still retain a valid claim for Care expenses under article 9, in this eventuality your claim will be released and you will have no further liability to us.
1.13 If the Panel Solicitor proceeds with enforcing your claim, we reserve the right to charge you 15% legal action fee in addition to the service fee , but will exempt you from paying the costs incurred in conjunction with such legal proceedings in case the lawsuit is lost. In the case of a settlement, the legal fees – unless they are borne by the airline – will also be borne by us. You will not be charged court or solicitors fees other than the legal action fee, described in 1.6.
1.14 You authorise Flight Delay Claims Team to accept out-of-court settlement offers and the Panel Solicitor to accept in-court settlement offers on your behalf without any further consultation, if the airline offers you a cash payment of at least 75% of the claim. The justification or explanation of the acceptance of the settlement or the transfer of legal documents can be demanded.
1.15 You are giving permission that the relevant compensators may make payment of your damages to us and permitting us to deduct any sum owed to us from any final or interim damages paid in your favour.
1.16 It is the lead claimant’s (i.e. the person submitting the claim) responsibility for accuracy of information provided. As such when completing a claim form, in entering other passengers’ name’s and claiming on their behalf, you are stating you have their express permission to put forward their details and claim. You should only do this if you have their express permission to act as their agent.
1.17 In the event that a panel solicitor or legal representative is used for Legal Action, the Client will allow us to grant them access to all of the data communicated to us and allow the legal representative to transfer information concerning the proceedings to us. Where a separate COA, Power of Attorney, Statement of Truth, Assignment Form or other additional documents are required by the relevant court, the Client undertakes to sign such additional documents. In case the Client has already signed an Assignment Form and signs a COA, Power of Attorney, Client Care Agreement or similar, the Client and ourselves agree that such Claim is automatically assigned back to the Client immediately prior to the Client signing the COA, Power of Attorney, Client Care Agreement or similar.
2.0 Obligations to co-operate
2.1 In order to be able to enforce your claim successfully, we depend on your support. That means that you inform us completely and correctly, not only when you order our services but also during the entire process. This requirement to co-operate extends to our panel solicitors also.
2.2 Even without a specific request, you agree to provide us with all the data and documents that are required for processing your case, including but not limited to; boarding passes, delay notification, correspondence with the airline, copies of all claiming passengers passports, and current utility bill. If you fail to submit the documents or the information, we are entitled to terminate the contract after informing you previously and observing an appropriate period of notice. Our invoice will be due in any case.
2.3 Any paper copies of documents can be returned, if an SAE is provided at the time of submission.
2.4 If you (a) provide incorrect or incomplete data against your better judgement or intentionally, or if (b) you have withheld

from us that you have already received compensation from the airline for the applicable claim or previously instructed a third party, Flight Delay Claims Team reserves the right to assert its claim against you for the resulting damage.
2.5 If you receive any direct payments or any other type of compensation, e.g. flight voucher, from the airline or third party after or before engaging our services, you are obligated to inform us immediately. You are obligated to pay our commission in any case.

2.6 To achieve an optimal result for you, you are obligated to refrain from negotiating with the relevant airline or third party upon engaging our services. If you do, we will deem this a breach of contract and our full fees are due in any case.
2.7 While the contract is in effect, you may not transfer the claim to another entity (e.g. a solicitor or a board of arbitration) for the purpose of collection, and you may not initiate any legal action on your own, either. If you do, we will deem this a breach of contract and our full fees are due in any case.

2.8 Failure to sign our Assignment Form / Letter of Authority means no contract has been entered into with FDCT. 2.9 Having signed our Assignment Form / Letter of Authority the contract has been entered into and commenced. Subsequent failure to sign the required panel solicitors Assignment Form or Letter of Authority does not remove your contractual obligations to us, nor your liability for costs

3.0 Fees
3.1 The service fee is calculated by all benefits granted by the airline before or after you ordered our services. If, with your permission, the compensation is not paid using money but by means of payment in kind, e.g. flight voucher, we are entitled to a success commission by cheque, in the amount of the value in kind. The entitlement to the service fee exists even if the benefits are given directly to you or via a third party.
3.2 The service fee, as well as any other possible fees, are calculated, depending on the country and based on whether the claim can be enforced in-court or out-of-court, when the letter of authority signed by you, arrives with us within 30 days of the data submission; the calculation is as follows:
Service Fee – 25% + VAT at 20%
Additional Fees – £20 Per passenger claiming + VAT at 20%
3.2a Should you wish to use our services on an hourly basis, our rate will be £97.50 + VAT.
3.3 If the Assignment Form / Letter of Authority reaches Flight Delay Claims Team later than within 30 days, the service fee for Flight Delay Claims Team shall, in any case, be 35% plus 20% VAT of the collected claim or of the flight voucher. 3.3a If in any circumstances we pass your case to a panel solicitor we may chose to charge our Legal Action Fee, this will be 15% + VAT. This may be applied in addition to any other charges.
3.4 Serving any and all documents to you by email is deemed acceptable by you.
3.5 Flight Delay Claims Team is entitled to deduct any fees from the airline’s payment. If the airline makes a payment directly to you, you undertake to pay out the commission to Flight Delay Claims Team without delay after you have received payment or invoice, whichever is sooner.
3.6 Payment is due to ourselves within 14 days if payment is made to you or within 14 days of our invoice, whichever is sooner. You may be charged for any collection fees if we instruct debt collectors, or similar, after that date. Outstanding balances may incur a 2% interest rate per month until settled.
3.7 If you send us any data, for example, a postal address (name, street, house number, postal code, country) in incomplete form, and this leads to delays and/or manual administration works regarding the processing of your claim, we are entitled to charge a processing fee of £25.00 (plus VAT) in the case of a successful outcome of your claim.
3.8 If our invoice remains unpaid after 14 days, we reserve the right to increase the invoice to our minimum invoice fee of £200 + administration fee of £20 per passenger + VAT.
3.9 In the case of default upon our invoicing, we are entitled to charge a late payment / reminder fee of £29.50 plus VAT for each and any subsequent correspondence, eg, emails, phone calls, letters or texts. In the case of default of payment of an invoice, an initial legal charge of £70 + VAT is payable.
3.10 As the registered office of Flight Delay Claims Team is located in England, the amount of VAT to be paid as stipulated by English law and is calculated in accordance with the legally stipulated rate (currently 20%).
3.11 All legal interest that would be allowed by the Courts that does not fall under the capital sum due to the client will go to Flight Delay Claims Team unless otherwise agreed in writing.
3.12 All funds collected from the Airline after the Agreement has been entered into that relate to the Claim will be regarded as having been collected as a result of Flight Delay Claims Team’s efforts and activities. Flight Delay Claims

Team will always be entitled to 25% of the claimed total with regard to funds received from the Airline.
4.0 Payment processing
4.1 Payment is usually made to you via cheque, and sent in the post to you at the address provided by yourself. It is therefore important to ensure you provide us with your correct and full postal address.
4.2 The costs that may result from the currency conversion from Euros or when transferring money from your account to another account are borne by you if applicable.
4.3 It is the lead claimant’s responsibility for the accuracy of information therein provided and their duty to request other passengers they put forward to complete an Assignment form / Letter of Authority and provide any other information that is requested.
4.4 If the airline contacts the passengers direct they must notify Flight Delay Claims Team in writing, preferably by email to [email protected] they must also forward any correspondence to Flight Delay Claims Team. This is applicable to all correspondence from the airline in regards to the delay. This must be done within 7 days.
4.5 If Flight Delay Claims Team carry out legal proceedings based on information supplied that is then proven incorrect you may be liable for any and all costs due in any case.
4.6 If you do not notify us of any correspondence or direct payout within 14 days of receipt and we reserve the right to issue court proceedings, you may be liable for costs due in any case.
4.7 No interest will be paid to the claimant, even if the airlines agree to pay.
4.8 If the airline has made the compensatory payment directly to you or if you have received a voucher or benefit, you are obligated to pay the commission to Flight Delay Claims Team by transferring the amount to the following Bank account: Account holder: E.ASTHAMPTON LTD
Bank: HSBC
Sort Code: 40-33-33 Account number: 62010313
4.9 If the claim is partly collected, our fees will still stand as described in 1.6
4.10 Flight Delay Claims Team may choose to pay you via cheque, as such this will be sent to the postal address you submitted. Payment to you will be in full and final settlement. We will not charge you a cheque fee.
4.11 Flight Delay Claims Team will pay your compensation payment within a maximum of 30 days after payment has been received into our bank account from the Airline, subject to receipt of written confirmation from the Airline identifying which claimant the funds are to be allocated towards.
4.12 You must notify us immediately if you receive any direct correspondence from the airline and most importantly if you receive compensation; failure to do so may lead to court costs being awarded against you and the airline will seek to recover said costs from you directly and not from us.
5.0 Right of Cancellation and instructions on the right of Cancellation for consumers
5.1 If you are a consumer, i.e. if you are a natural person that concludes the legal transaction for the reason that can be considered neither a commercial nor an independent professional activity, You have the statutory right of cancellation, regarding which we inform you as follows:
INSTRUCTIONS ON THE RIGHT OF CANCELLATION Right of Cancellation see separate notice
5.2 You have the right to cancel this contract within 14 days, without needing to state any reasons. The 14-day deadline for cancellation begins on the day the ASSIGNMENT FORM / LETTER OF AUTHORITY IS SIGNED AND SUBMITTED. To comply with the deadline for cancellation, it suffices to send the notice of cancellation in due time. The notice of cancellation is to be addressed to Flight Delay Claims Team, Whitworth Chambers, George Row, Northampton, NN1 1DF. England, or to [email protected] using a clear statement (letter sent preferred by recorded delivery, or e-mail stating the case number).
5.3 Consequences of cancellation
If you cancel this contract, we shall be obligated to refund you any payments that we received from you, including the delivery costs (except the additional costs incurred if you chose to have a delivery made by different means than the one offered by us, i.e. inexpensive standard delivery), without delay and no later than within 14 days of the day on which we received the notice of your cancellation of this contract. For this process of refunding we will use the same payment method that you used for your original transaction unless a different method was explicitly agreed with you; under no circumstances do we charge you any fee for this refund.
5.4 If you demanded that the service must begin within the 14 day cancellation period, you must a) notify us in a durable

form that you have made such an express request, and have waivered your right to cancel the agreement within the 14 day cancellation period, b) You must notify us in a durable medium that you are prepared to pay us our fees as outlined in this document. .
5.5 If you decide to withdraw from the agreement after the initial 14 day cancellation period has passed, but before any acceptance of the claim has been made or received from the carrier, then we will charge you for works carried out up to the date of cancellation. This charge will be calculated using our hourly rate of £97.50 + VAT. Should you wish to cancel after acceptance or payment of the claim has been received/acknowledged by the carrier, we have the right to charge you the full fee of 25% (formerly referred to as the Service Fee) plus any due administration fees. If we have passed your claim to one of our panel solicitors the Legal Fee will also be due in full.
5.6 If you decide to withdraw from the agreement after legal instructions have commenced we have the right to charge you any legal expenses incurred to date in addition to the service fee and administration charge.
5.7 Special Notes. Your right of cancellation expires early if Flight Delay Claims Team had already provided the service in full and did not provide the service until after you explicitly gave your approval and if, before the implementation of the services, you acknowledge that you would lose your right of cancellation if we fulfilled the contract completely.
6.0 Term of contract
6.1 The contractual relationship ends through termination on the part of the client for important grounds under the provisions and the general obligation to cooperate in accordance, when the claim is settled in full or in part, by payment or by means of a flight voucher, or if – after a detailed examination of the case – Flight Delay Claims Team or the commissioned contract solicitor respectively determines the pointlessness of a continued pursuit and you are informed accordingly via e-mail.
7.0 Data Protection Statement
7.1 Flight Delay Claims Team will use your personal data for enforcing your claim.
7.2 By submitting your details, you are opting into receiving correspondence from us. Applicable law and place of jurisdiction
7.3 The laws of English jurisdiction apply to this contract, whereas the UN Convention on Contracts for the International Sale of Goods is excluded. If the client is an entrepreneur, a legal entity under public law or a special fund under public law, the sole place of jurisdiction for all claims resulting from this contractual relationship shall be England.
7.4 Information given on this website is for illustrative purposes and general information only. Any indication of whether a flight is eligible and any amount is only an indication and not to be relied upon. Its contents are believed to be correct according to our opinion concerning the state of law. The website expresses opinion as well as fact, regulations and law are complex and may be open to different interpretations.
7.5 In giving information in this website unstated assumptions or generalization may have been made and consumers should refer to the detailed European Regulations for definitive information. Furthermore, regulations, rules, and law have been amended at dates in the past and may be amended in the future and such changes may affect the law applicable to any particular case defendant know when the cause of action occurred, or in the proceedings are issued. Due to the international nature of air travel and in particular Domicile & Residence research of each airline and claimant, there may be questions of applicable law and jurisdiction to consider in individual cases. The advice in each individual case is always fact sensitive.

7.6 Compensation in many types of flight dispute cases is valid in Euro and where on this website or on any of our advertisements, we have quoted GBP equivalents. This has been calculated at an illustrative exchange rate of 1.12 Euro = 1 GBP. The rate applicable to any individual claim may vary according to a number of factors and how those factors are applied (if at all) may vary from case to case but which include: the exchange rate applicable on the date of the flight in question, the exchange rate applicable on the date of any court proceedings are issued, the exchange rate applicable on the date of payment or settlement is agreed or made, the attitude of individual judges as to the appropriate reference date for ascertaining the applicable exchange rate, the extent to which individual airlines seek to take issue in relation to questions of applicable exchange rate and/ or currency in which the settlement is to be paid. Different exchange rates may be implied to compensation awards for passengers on the same affected flight. The exact calculation of compensation due in respect of any individual claim is determined according to the provisions of the regulation (EC261/2004) including that a small number of circumstances the airline will be entitled to apply a 50% discount. Euro equivalent compensation awards for delay compensation are indicated below.

Flight destination within the EU
€250 compensation for a delayed flight up to 1,500km delay for over 3 hours. €400 compensation for a delayed flight over 1,500km delay for over 3 hours.
Flight destination outside the EU
€250 compensation for a delayed flight up to 1,500km delay for over 3 hours.
€400 compensation for a delayed flight over 1,500km up to 3,500km delay for over 3 hours.
€300 compensation for a delayed flight over 3,500km delay for over 3 hours but less than 4 hours. €600 compensation for a delayed flight over 3,500km delay for over 4 hours.
Effect of charges on compensation received:
Example – if the exchange rate used to calculate the award is 1.2 Euro = 1GBP, and the compensation amount is €400. GBP award: £333; 25% of £333 = £83.25, add £20 = £103.25, add VAT (20%) £20.65 total charging including VAT = £123.90 Net
Compensation payable to passenger is £333 – £123.90 = £209.10 9.0 How to complain
Flight Delay Claims Team (E.asthampton Ltd Trading as)
8.0 How to make a complaint:
8.1 At Flight Delay Claims Team, we constantly strive to provide a high standard of customer service, but there may be occasions when you, as our customer, are dissatisfied. We take all customer complaints seriously within Flight Delay Claims Team, and want to hear your concerns in order to improve our service in the future. This document outlines what you should do if you wish to make a complaint, and also our commitment to you.
8.2 What you need to do:
You can make a complaint in writing – by letter, email or verbally over the telephone. You should explain the facts in a logical order and remember to provide us with a claim number, name and full address to enable us to locate your details and look into your concerns as soon as possible. Our contact details are:
The Complaints Department,
Flight Delay Claims Team (E.asthampton Limited,) Whitworth Chambers, George Row, Northampton NN1 1DF
We can be emailed at [email protected] with the subject set as “Complaint.”
8.3 What we will do: Investigation of your complaint.
Your complaint will be assigned to a nominated person who has not been involved in the processing of your case, where possible, who will seek all relevant facts, and there may be a need for us to contact you. They will also refer to any documentation held, and any relevant third parties where appropriate.
8.4 Timescales
We will acknowledge your complaint within five working days and provide contact details should you wish to communicate with us at any time during the investigation.
We then have 8 weeks from the date we receive your complaint to make our decision. If after 8 weeks, we have been unable to resolve your complaint, we will write to you providing an update on our progress, and let you know when we expect to be able to provide our final response. We will always try to reach a conclusion within the written timescales, but if we are unable to do this, perhaps due to the complexities of the case, we will write to you again at this point, providing details of the progress of our investigation at this stage.
8.5 If we conclude that you have been poorly advised, or suffered material loss or inconvenience, we will make proposals to put things right for you. If this is not the case, then we will write to you explaining how we reached our decision.
8.6 Complaint Outcome
Once all the information available has been reviewed, we will contact you with our findings and decision. Where appropriate we will outline exactly what form of redress we will take..

9.0 Instruction of our Nominated Panel Solicitors (The Firm):
9.1 Our Nominated Solicitors are working in conjunction with us on all legal claims for flight delay compensation under EC Regulation EU261/2004, US Code of Federal Regulations, The Montreal Convention, and the Regulation On Air Passenger Rights . We will pass all the details of your claim to the Firm and they will pursue your compensation claim through the legal procedure, in accordance with this agreement.
9.2 Our Nominated Solicitors operate on a fee sharing agreement with us. This has no effect on the ‘No-win, No-fee’ agreement. They will also act for you on a ‘No-win, No-fee’ basis. If your claim is Issued at Court, upon success, the Firm

will also retain, as fees, all Statutory Interest added, Court costs awarded and recovered disbursements (such as Court issue fees which the Firm may have paid on your behalf). If you do not wish our Nominated Solicitors to act on this basis, then you must inform either, Flight Delay Claims Team or our Nominated Panel Solicitors, immediately, in writing, by telephone or e-mail.

9.3 Upon success, you will receive the full compensation amount originally claimed, less the Service Fee, as stated above. In addition you may be charged a Legal Fee if our Panel Solicitor has become involved.
By agreeing to these terms you authorise (but do not limit) the Firm to;

• ●  Conduct an investigation to include the Airline providing and discussing (where necessary) all requested information with the Firm;
• ●  Authorising the airline to release copies of all papers relating to your booking on the stated flight;
• ●  Authorising the airline to release information under the Right of Access to Personal Data Sections 7, 8 and 9of the Data Protection Act 1998;
• ●  To receive and process any payments that may become payable to you.If you understand and agree to our terms and conditions, please feel free to continue and submit your flight delay claim for compensation for; delayed or cancelled flights, or if you were denied boarding
  10.0 Instructions for Cancellation
  10.1 Right to cancel. You have the right to cancel this contract within 14 days without giving any reason.10.2 The cancellation period will expire after 14 days from the day of the commencement of the contract, ie the signing of the Assignment Form/ Letter of Authority
  10.3 To exercise the right to cancel, you must inform us E.asthampton Ltd, trading as Flight Delay Claims Team, Whitworth Chambers, George Row, Northampton NN1 1DF, 01604 632255, [email protected], of your decision to cancel this contract by a clear statement (e.g. a letter sent by post, fax or e-mail). You may use the attached model cancellation form, but it is not obligatory.10.4 To meet the cancellation deadline, it is sufficient for you to send your communication concerning your exercise of the right to cancel before the cancellation period has expired.
  10.5 Effects of cancellation
  If you cancel this contract, we will reimburse to you all payments received from you, including the costs of delivery (except for the supplementary costs arising if you chose a type of delivery other than the least expensive type of standard delivery offered by us).We may make a deduction from the reimbursement for loss in value of any goods supplied, if the loss in the result of unnecessary handling by you.
  We will make the reimbursement without undue delay, and not later than:
  A) 14 days after the day we receive back from you any goods supplied, orB) (if earlier) 14 days after the day you provide evidence that you have returned the goods, or
  C) if there were no goods supplied, 14 days after the day on which we are informed about your decision to cancel this contract.
  We will make the reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise; in any event, you will not incur any fees as a result of the reimbursement.
  10.6 If you requested to begin the performance of services during the cancellation period, you shall pay us an amount which is in proportion to what has been performed until you have communicated us your cancellation from this contract, in comparison with the full coverage of the contract. Please see other cancellation charges due as outlined in 5.5 and 5.6

10.7 Model cancellation form
To E.asthampton Ltd trading as Flight Delay Claims Team, Whitworth Chambers, George Row, Northampton, NN1 1DF. [email protected]
I/We [*] hereby give notice that I/We [*] cancel my/our contract of sale of the following goods [*] / for the supply of the following service [*],
Ordered on [*] / received on [*],
Name of consumer(s), Address of consumer(s),

Signature of consumer(s) (only if this form is notified on paper), Date [*] Delete as appropriate