Agent Application Form

Basic Company Details
- Company Name*
- Address Line 1*
- Address Line 2
- Town / City*
- County / Province / Region*
- Postal Code*
- Country*
- Contact Telephone Number*
- Email Address*
- Website
Further Company Details
- Managing Director's Name
- Contact Person's Name
- Year of Foundation
- Number of Employees
- Do you have a sub office?
  - Yes
  - No
- Sub Office Address
  - Address Line 1
  - Address Line 2
  - Town / City
  - County / Province / Region
  - Postal Code
  - Country
- Membership of Professional Bodies
- Number of students enrolled on English language courses in the UK in the last 6 months
Referees
- Please provide details of two professional referees who you have worked closely with in the past 12 months. Where possible, these should be English language school providers.
- Referee 1
  - Name
  - Company
  - Address Line 1
  - Address Line 2
  - Town / City
  - County / Province / Region
  - Postal Code
  - Country
  - Contact Telephone Number
  - Email Address
- Referee 2
  - Name
  - Company
  - Address Line 1
  - Address Line 2
  - Town / City
  - County / Province / Region
  - Postal Code
  - Country
  - Contact Telephone Number
  - Email Address
Conditions
- Privacy
  Yes, I consent to the processing of my personal data in accordance with Anglo-Continental's Privacy Policy, and would like to receive the latest news, offers and information from Anglo-Continental.
  - I agree
- Please read through the Anglo-Continental Conditions for Agents (PDF, opens in new window). You will be required to agree to these conditions below.
- I agree to abide with the Anglo-Continental Conditions for Agents*
  - I agree
- CAPTCHA
Name
This field is for validation purposes and should be left unchanged.