Website Enquiry / Prize Draw Entry Form :. Silver Fern Services Ltd

To Silver Fern Services Limited ; please treate the below completed form ;

(a) As a commercial enquiry. Please respond promptly (tick if appropriate)
(b) As my FREE entry in your current prize draw / sweepstake (tick if appropriate)

Fields marked with * are required

	Prefix *	Initials * (Max 3)	Forename *	Surname *
Type your name	Prefix is required	Initials are required	Forename is required	Surname is required

You have given your name as ;
		If this is incorrect, or, the cAsE is mis-typed, please re-type it.

Given your name prefix are you male or female ? Please advise.

Please now provide your ;

Business / Company name *

Business Position / Title *

Country

State / Province

City / Town

Operational Location
(No need to complete if in the U.K.)


Area Code	Number	Extension

** Direct Landline * (* and / or)

* Business Mobile * (** and / or)

Business E-Mail Address *

Type any message you wish to send here:

Please also provide your Business ;


Area Code	Number

Switch Board Tel No

Switch Board Fax No

Website Address (where applicable)

Where I have above indicated that I wish to be entered into your current prize draw / sweepstake, I confirm that ; I am 18 years or more of age, my entry will not contravene any contract of employment I have, or, law applicable to me in my country of residency and I fully accept the complete terms and conditions of entry.

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