Isle of Wight Council

	Apply for an AllPay Payment Card
	If you wish to apply for an AllPay Payment Card, please provide us with the following details. To find out more please visit the AllPay Website.

*

Council Tax Account No:

*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Telephone number (include area code)

Please provide details of where you would like your AllPay Card to be sent to (if different from above):

	Recipient's Name
	Recipient's Address:

If you are not submitting this form online, please print it out and hand it in at any of the council offices or send it to: Revenue Services Division, Council Offices, Broadway, Sandown, Isle of Wight PO36 9EA Tel: (01983) 823901

	Council Tax Privacy Notice
	The Isle of Wight Council as data controller, will process your personal information contained in this application in accordance with the Data Protection Act 1998. Information may be shared with other departments within the Council for the recovery of any debts owed to the Council and to identify persons responsible for Business Rates and/or Council Tax & bringing empty properties back into use. Please note that the Council may share your information in the absence of consent, for the purpose of crime prevention or detection, in accordance with the law. Please click here to read the full Privacy Notice.

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013