Licensing request for advice or assistance form Contact Details Title Required Please select ... Mr Mrs Miss Ms First name Last name Required House / flat number or name Road Area Town / city Postcode Ward Email address Telephone number I prefer to be contacted by:- Tell us how we can contact you. Required PhoneEmailPost Organisation name Help: If enquiring on behalf of an organisation - provide organisation name. What type of licence are you enquiring about? Please select ... Licensing Act 2003 Gambling Act 2005 Charitable Street Collection House To House Collections Massage And Special Treatments Scrap Metal Dealers Sexual Entertainment Venues Sex Establishments Shop Cinema Skin Piercers Other Would you like a licence application form sending to you? Required YesNo Next By submitting this form you agree to Birmingham City Council processing your data in accordance with our terms and conditions and privacy statement.