WELCOME FORM

New Agency Fact Finder

Please take a moment to complete the form below so we have all the practical information we need to begin working with you - we’re excited to get started!

Agency Information

Agency Name(Required)

Registered Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Number(Required)

VAT Number(Required)

Agency Contact Information

Primary Contact(Required)

Primary Contact Office Address

(if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title(Required)

Email(Required)

Contact Number(Required)

Invoice and Payment Contact Information

Contact name for invoice processing and payments(Required)

Is your agency self-billing or do you require invoices?(Required)

Self-Billing

Require Invoicing

Email(Required)

Contact Number(Required)

Invoice Address

(if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Authorised Signatory

Name(Required)

Email(Required)

Contact Number(Required)

Information Provided By(Required)

First Last

Date(Required)

Who we help

Why Workwell

Resources

New Agency Fact Finder

Agency Information

Agency Contact Information

Invoice and Payment Contact Information

Authorised Signatory