Agent Registration Form

Manchester College of Higher Education and Media Technology

Building Careers through Skills Development and Education

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Agent Registration Form

Name of the Company**:
Company Type:	Limited Partnership Proprietor Others
Contact Person**:
Work Address:
Telephone (incl STD):
Fax:
E-Mail**:
Website:
Company Bank Details:
Name of the Bank:
Branch Name:
Branch Address:
Bank Account No:
Branch_code:
Trading Since:
Geographical Region Covered:
Other Branch Offices:
Type of Recruitment of Students**:
Other Universities or College Represented in UK:
Terms and Conditions**:
Signed and Date:

(** Required Fields)

TV House, 57-63 Cheetham Hill Road,

Manchester M4 4ET, England, UK
MCHEMT is approved by UK Border Agency under Tier 4; Sponsorship Licence Number:4P85WJNR7