First Name(s)

Surname

Title / pronouns (optional)

Address line 1

Address line 2 (optional)

Post Code

Telephone Number

Your email

If you are already an investor, please give your Shareholder Number

I wish to become an investor member of Radical Routes Limited and hereby apply for Withdrawable Shares (minimum 50) of £1 each subject to the rules of the society and the conditions set out here.

Interest (Please tick STANDARD, HALF or NONE below)

STANDARD - I wish to purchase shares which receive the standard rate of interestHALF - I wish to purchase shares which receive half the standard rate of interestNONE - I wish to purchase shares which receive no interest

Please provide details of a nominated bank account. Payment for shares must be made from this account and all withdrawals will be paid to it.

Bank

Account Name

Sort Code

Account Number

How should we contact you?

We would like to communicate with you by email but we need your consent
to do that. Our member communications with you will include information
about our AGM and details about how to take part in our elections.

Please let us know how you would like to hear from us.

Even if you choose to receive member communications by email, you can
request printed copies of information at any time, free of charge.

You can also change your instructions at any time by writing to us at
investors@radicalroutes.org.uk

I prefer to receive printed material by postI prefer to receive member communications by email

I have read and accept the Radical Routes Withdrawable Shares - Notes and Conditions

Where did you hear about Radical Routes? (optional)

When we get your completed form, we will be in touch with details of how
to pay for your shares.

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