Pearl Series Nomination Form
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What's your name? *

 
Your involvement with the horse: *


 
Address

 
Phone Number:

 
Mobile Phone

 
Your Bank Account details

 
Branch

 
A/C

 
How many yearlings would you like to nominate? *

 
Yearling #1

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #2

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #3

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #4

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #5

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #6

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #7

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #8

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Yearling #9

 
Sire & Suffix *

eg AUS, USA
 
Dam & Suffix *

 
Declaration *

I declare I am authorised to make this/these nominations and the nomination(s) is/are eligible to be nominated
     
 
GST

 
Nominator's GST Number (if applicable)

 
Owner's GST Number (if applicable)

 
Insurance Options

 
Insurance options

* An endorsement will be made to your existing policy to include the 'LifeSaving Surgery' extension

 
Insurance required for:

Please enter a dollar amount
 
Payment Options *


Thank you for your nominations. As you mentioned you'll like to pay with Credit Card, you will now be taken to our payment portal to pay
Pay Now
Thank you for your nominations. Don't forget to submit your payment via Direct Credit / Internet Banking, or by cheque

Credit NZTBA Pearl Series: BNZ A/c No: 02 0360 0105172 00