Elite Title Application Form

Private & Confidential

Just print this out, fill in and mail.
(If you require a pair of titles, please print this form twice).


Please Complete In CAPITAL Letters

This Title is: FOR ME  /  A GIFT (Please indicate)

Today's Date:______/_______/_______ (DD/MM/YY)

CURRENT TITLE: Mr/Mrs etc _______________________

FULL NAME:_____________________________________

ADDRESS:_______________________________________

_______________________________________________

COUNTY / STATE:__________________________________

POSTAL CODE / ZIP:_______________________________

COUNTRY:______________________________________

NATIONALITY:___________________________________

TEL.NO:________________________________________

FAX.NO:________________________________________

PURCHASER'S EMAIL:____________________________

DATE OF BIRTH (if under 18):_________________________________

HOW DID YOU FIND OUR WEBSITE?

SEARCH ENGINE / ADVERT / OTHER: _________________

NEW TITLE REQUIRED
Choose from:
Lord, Lady, Baron, Baroness, Count, Countess, Viscount,

Viscountess, Marquess, Marchioness, Duke, Earl, Duchess,

Sir, Dame, other

TITLE:________________________

I the undersigned declare that the information provided is correct and true. I

therefore submit this application to MBC (Dept.ET) to provide me with the

above effective Title. I understand that these effective Titles are not to be

mistaken for real Titles (bestowed by the State, etc) or used for any fraudulent

means.

Signed:......................................................  Date .....................................

All fees are charged in Pounds Sterling.

SINGLE TITLE

E.G.: "LORD"

£195  

PAIR OF TITLES

E.G.: "LORD & LADY"

£299  
     
SHIPPING/HANDLING COSTS
UK £4.99  
REST OF THE WORLD £9.99  
3 WORKING DAY SERVICE £50  
     
EXAMPLE
SINGLE TITLE £195  
Shipping to USA £9.99  
3 Working day service £50  
TOTAL £254.99  

 

PAYMENT

We accept cash in US$ or £Stg. Please send by registered Airmail. We can also accept cheques drawn on a British Bank in £Stg. and International Money Orders also in £Stg., but reserve the right to clear the funds before dispatch. Please make cheques, money orders payable to MBC.

We can email you an invoice which you can pay securely with your credit/debit card, please supply your email address:.........................................................

PLEASE LET US KNOW BY EMAIL WHEN YOU HAVE MAILED YOUR APPLICATION.

OUR CONTACT DETAILS

Airmail your Application with payment to:

Andrew Bulpin t/a

MBC
86 Queen Street
Newton Abbot
TQ12 2ET
Great Britain

UK Tel: 01626 572123
International Tel: +44 1626 572123

MBC - ESTABLISHED 1990
"PRIVACY AND INTEGRITY ASSURED"