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Enhance your services and help build your business with intasure.

Fill out the form below to become an intasure introducer.
Fields marked with an asterisk (*) are required.

Company details
Applicant's full name *
Trading name (if different)
Introducer number
(if applicable)
Recommended by (name)
Type of organisation
Property developer
Estate agent
Letting agent
Property management
Other (please specify below)
Date business established *
Company registration number
(if applicable)
Names of all pricipals,
partners or directors *
Business trading address *

 
 
 
 
 
Contact name *
Telephone *
Fax
General email address *
Web site

Head office details
Head office address
(if different)

 
 
 
 
 
Head office contact name
Telephone
Fax
General email address
To which regulatory bodies / institutions do you belong (please specify)?

PORTUGUESE BANK - Payment details
Bank name
Account name
Bank number
Branch number
Account number
Bank address

 
 
 
 
 

Terms of business
Click here to view terms of business

Application
I have read Intasure's Terms of Business, and would like to become
an Intasure Introducer.

If you have any enquiries regarding this form,
call us on +44 20 8274 6756.
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