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Graded Membership Application Form

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To become a Graded LPHCA Member, please fill out the form below. Please be aware that our Membership is only available to Licensed Private Hire Operators.

Please note required fields are indicated with *

Company Name *

Title * Name * Surname *

Position in Company

Address including Postcode *

Please leave no spaces on Telephone, Fax, etc. fields

Company Telephone Number*

Fax Number

Mobile Number

Direct Telephone Line

Number of Vehicles * (this will appear on your listing on our website)


Email Address *

Alternate Email Address

How did you hear about us? (e.g. Web, Magazine, etc.)

Additional Comments

I am aware that by clicking submit a payment deposit of £100 will be required before this application can be processed for Graded Membership.