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
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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