Thank you for considering Book and Host for your Internet payment solution. This form will     allow us to undertake a rapid business assessment of your company as a potential customer  of BookandHost.com. The form is secure, and any information that you provide will only be  used for the purposes of assessing your application.

 Part of our acceptance procedure involves a credit check and we ask you to complete this  form fully, so that we can carry this out. You must answer all questions for your application  to be considered. If you require any assistance in completing this form, please contact us at  sales@bookandhost.com
 or 91 891 2755103

 Since you will be providing sensitive personal and financial information we have taken careful  attention to ensure that our application is completely secure and that all transmitted  data passes through SSL encryption for your protection. You can verify your  secure connection by clicking on the secure lock icon at the bottom of this page.

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