Private Members Application Form

 

To join my Private Service, fill out form; Right click and select print. Then send it off with your Cheque, postal order or bank draft  payable to:- 'm k cowlishaw esq.'
   
 
Title:     Name:
Address:    
    
    
    
Post Code:   
E-Mail:   
Tel:   
Mobile:   

Are you aged: 

  Up to 25
                   

26-40               

41-60
     

60+

Are you a member of any other racing club OR Tipster?

   Yes    No                If yes, plse list which one(s)?

           

How did you hear of TurfAgent?

 

DAILY SERVICE: 
Please tick payment option

£ 49.00 ( 1 mth)        £139.00 ( 3 mths)       £495.00 (12 mths)     

MAXBET SERVICE: 
Please tick payment option
£ 49.00 ( 1 mth)         £299.00 (12 mths)     

LAY SERVICE: 
Please tick payment option

£595.00 (12 mth)       £795.00 (24 mths)      £ 995.00 (36 mths) 

I AM ACTING AS AGENT FOR THESE RACING SERVICES, WHICH WILL BE AVAILABLE TO A RESTRICTED CLIENTELE. THIS INFORMATION MUST BE FOR PERSONAL USE OF THE ABOVE NAMED ONLY AND MUST NOT BE PASSED TO ANY THIRD PARTY.

SIGNED ________________________________ DATED: ___________________________________
Please send form & your membership fee;(Cheque, P. Order, Bankers Draft, Cash (Reg. Mail) to:  

Martin K Cowlishaw, C/o 3 Lovey's Croft, Breedon on the Hill, Derby, Derbyshire, DE73, 1HZ, UK