Lisburn Online Forms - Skin Piercing Procedures

Title:

First Name:

Last Name:

E-mail:

Main telephone number:

Other telephone number:

Street Number and Name:

City or Town:

Post code:

Country:

Is your business registered in the UK with Companies House?:

YesNo

Is your business registered outside the UK?:

YesNo

Registration Number::

Legal Status:

Legal Status - Other:

Your position in the business:

Premises Name:

Street Number and Name:

City or Town:

Postcode:

Country:

Acupuncture:

YesNo

Tattooing:

YesNo

Semi-permanent skin colouring:

YesNo

Cosmetic Piercing:

YesNo

Electrolysis:

YesNo

Other:

YesNo

Applicant Details
Title:
First Name:
Last Name:
E-mail:
Main telephone number:
Other telephone number:
Street Number and Name:
City or Town:
Post code:
Country:
Your Business
Is your business registered in the UK with Companies House?:	YesNo
Is your business registered outside the UK?:	YesNo
Registration Number::
Legal Status:
Legal Status - Other:
Your position in the business:
Business address (if different from above)
Premises Name:
Street Number and Name:
City or Town:
Postcode:
Country:
Treatments
Acupuncture:	YesNo
Tattooing:	YesNo
Semi-permanent skin colouring:	YesNo
Cosmetic Piercing:	YesNo
Electrolysis:	YesNo
Other:	YesNo