14 Hasler Rd, Osborne Park, WA 6017 | Ph: (08) 9445 5277 | email: [email protected] westspeed.com.au | ABN: 21 347 055 603
RACING AND WAGERING WESTERN AUSTRALIA WESTSPEED STANDARD OWNER NOMINATION FORM
2020 Nomination Details for 2018 Foals
Horses by a Westspeed Platinum Stallion will be considered as Westspeed Platinum during their race career, earning further bonuses during their two-year-old (2YO) and 3YO seasons. Owners have the option of paying a “4YO Extension for Platinum Horses Only” fee to become
eligible for bonuses for 4YO winners below 1750m. Please click here for the Westspeed Platinum Owner Nomination Form.
NOMINATOR DETAILS
This form does not need to reflect the full details of the yearling’s ownership. This information will be recorded when the ‘Application to Register a Horse’ form is lodged with the Registrar of Racehorses.
Name ______________________________________________________________________________________________
Address ______________________________________________________________________________________________
______________________________________________________________ Postcode ______________________
Telephone _________________________________________ Email ______________________________________________
NOMINATIONS CLOSE AT 4PM ON THURSDAY, 16 JULY 2020
NOMINATED YEARLING
DECLARATION
I declare that the details above are true and accurate, and the nomination(s) meet the criteria set out in the Westspeed Conditions.
Signature _______________________________________ Date __________ /__________ /_________
OFFICE USE ONLY
PI No: Receipt No: Date: Amount Paid: $
Option A: Westspeed Owner Nomination Only $2,200 (inc. $200 GST)
Sire Dam Sex Nomination Type Fee Paid E.g. Option A E.g. $2,200
Total Paid $
14 Hasler Rd, Osborne Park, WA 6017 | Ph: (08) 9445 5277 | email: [email protected] westspeed.com.au | ABN: 21 347 055 603
PAYMENT METHOD
If payment is made electronically, forms may be submitted by email to [email protected].
☐ Credit Card Complete below, or phone (08) 9445 5277
☐
BPAY Biller code and reference provided by email on receipt of Nomination Form
☐ Cheque Attach to Nomination Form
Cardholder Name
_________________________________________________________________
Credit Card (Please tick) ☐ VISA ☐ MasterCard
Card Number ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ CVV (3 digit number on reverse of card) ☐☐☐
Expiry Date
_________ / __________
Amount
$_________________________
Signature
__________________________
Date
__________ /__________ /_________
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