CCJ Form of Authority, Instruction and Fee Acceptance | Lender and Court Services

Please complete this Form of Authority, Instruction and Fee Acceptance so we can proceed with your case.
You will be emailed a copy of your completed form and our Terms & Conditions, for your records.
Claimant's Name*
Claim Number
Authority, Instruction and Fee Acceptance
I / We give full authority for Lender & Court Services Ltd to deal directly with the Claimant named above.
I / We agree for Lender & Court Services Ltd to speak to you and deal with my case, and give them full authority to discuss my case with you.
I / We agree that Lender & Court Services Ltd may forward copies of all the documentation we have provided in support of our case.
I / We allow you to discuss with Lender & Court Services the full details of the matter and supply them with copies of any documents they request directly from you to them.
I / We have read and accept the Terms and Conditions. Click here to view (the page will open in a new tab on your browser).
I / We agree to pay the fees quoted, as and when requested by Lender & Court Services Ltd..
Name*
First Last
Today's Date*
Day
Month
Year
Business Name
Email*
Address
Street Address Address Line 2 City County Postal Code
Signing the Form
To sign this form, you can simply draw your signature, using your computer mouse or trackpad, or using your finger on your phone or tablet.
Signature*

Please complete this Form of Authority, Instruction and Fee Acceptance so we can proceed with your case.