Step 1   -  Please complete the Declaration before you continue

It is important that you have no financial or family interest in any business or supplier you recommend. Please read and accept the full declaration.

FIrst name:		Surname:
Email:	Mr      Mrs     Miss      Ms
Address:
Telephone:	Daytime      Evening
To ensure we have a representative cross section of all the customers on the Island please tell us the following about yourself:
Age:	Marital status:	No. of dependent children:
14-17 18-25 26-35 36-45 46-55 56+	Married/living with partner Single/widowed/divorced
Homeowner:	Employment status:	Employment type:
Yes	Full time Part time Self employed Housewife/Househusband Unemployed Student Retired	- not applicable - Craftsman/tradesman Education/medical Manual/factory worker Office/clerical Middle management Professional Senior management
Confidentiality - click for more info