Victor Van Erpekom

Nomination Agreement Form

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Owners name & address _____________________________________________________________

_________________________________________________________________________________

Telephone No ______________________________ Mobile No ______________________________

EMail Address ______________________________

Name & address where semen is to be sent if different from above

_________________________________________________________________________________

Mares Details

Name ______________________________ Age ____________ Breed _________________________

Colour __________________________________ Height __________________________________

Sire ____________________________________ Dam ____________________________________

Reg. Society __________________________________ Reg. No. __________________________

Barren / In foal / Foal at foot __________________________ Last season date ___________________

Approx Date semen is required for ________________________ Fresh or Chilled semen ___________

STUD FEE £350 NFFR
(Includes 1st collection fee and postage via Royal Mail)

Should your mare fail to conceive, further attempts are of course possible, for which additional collection fee must be charged. Please see terms and conditions. All costs to be paid for in full before semen is dispatched.

PLEASE MAKE CHEQUES PAYABLE TO FOXRIDGE STUD, THANK YOU.

I agree to the terms and conditions of Foxridge Stud

Name ______________________ Date ___________________

Signed _______________________________________________

Please send a signed copy of both the Terms and Conditions form and Nomination form back to Foxridge Stud.