NOMINATION FORM

Please note: Electrum is not available to single or double dilute mares.

NOMINATION FORM TO ELECTRUM (USA)

NAME OF MARE ___________________________________________________

DATE OF BIRTH ___________________________________________________

COLOUR ___________________________________________________

HEIGHT ___________________________________________________

BREED ___________________________________________________

SIRE ___________________________________________________

DAM ___________________________________________________

DAMSIRE ___________________________________________________

PASSPORT/UELN No. ___________________________________________________

MICROCHIP NUMBER

___________________________________________________

STUD ARRIVAL DATE ____________________________________________________
or
SHIPPED SEMEN DATE ____________________________________________________

OWNERS NAME ____________________________________________________

ADDRESS _____________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

TELEPHONE NUMBERS ______________________________________________________

I hereby agree as the owner of the above named mare to accept the terms and conditions made by
the stud and Ms Leigh Ann Kerr (owner of Electrum) and confirm by signature my intention
to send the above named mare to or receive semen for the above named mare to/from ELECTRUM (USA)
and enclose £100.00 for the non-returnable booking fee made payable to Ms L A Kerr.

SIGNATURE & DATE ______________________________________________________

Nomination Form and payment to be sent to:
Ms L. A. Kerr
Shannon Leigh Stables,
Stable Lane,
Bexley,
Kent.
DA5 2AW

Bank Transfer
Bank : Barclays
Sort Code : 20 06 72
Account name: Ms L A Kerr
Acc No. : 7040 2915
Reference: Electrum/(mares name)