Please complete your Personal Information

Contact Name

Postal Address

Installation Address

Home Phone Number

Work Phone Number

Mobile Number

Email Address

Date of Birth

Drivers Licence Number

Please upload a copy of your Drivers Licence

Please complete the additional information requested below.

Reference Name

Reference Address

Reference Contact Number

Relationship with Referee Friend Work Colleague Employer Family Member Other

Reference Name (2nd)

Reference Address (2nd)

Reference Contact Number (2nd)

Relationship with Referee (2nd) Friend Work Colleague Employer Family Member Other

Please select equipment you would like to hire Bike Basic Bike Programmable Bike Recumbent Stepper CrossTrainer Basic CrossTrainer Beginner CrossTrainer Advanced Rower Magnetic Rower Hydrolic Vibration Machine BackSwing Treadmill Basic Treadmill Mid Range Treadmill Mid Range 2 Treadmill Top of the range

Please select your preferred payment plan 6 months 3 months 1 month

Please select your hire period 1 Month 3 Months 6 Months

Please select your preferred payment method Easy Debit Direct Deposit Paypal

Please confirm you have READ CAREFULLY and AGREE with the Terms and Conditions Yes No

Thank you for submitting your online hire form.  A member of staff will be in contact within 24hrs to confirm your hire request and process payment plan and documentation.

Many thanks