About you and your business Business rates account number Required Your business rates account number is eight digits long. Business name Required Your first name Required Your last name Required Your contact number Required Your email address Required Business address you are leaving Required Postcode Lookup Do you own the premises you are leaving? Required Please Choose Yes No Date you are leaving the premises Required Will any goods remain in the empty premises? Required Please Choose Yes No If you are moving to another premises in Stoke-on-Trent, what is the address? Postcode Lookup If you are moving to another premises in Stoke-on-Trent, what date did you move? Provide us with an alternative address to write to you at Postcode Lookup Bank account number Required (for possible refund purposes) Bank sort code Required (for possible refund purposes) Bank account name Required (for possible refund purposes)