CLA Game Fair Prize Draw Entry


To enter simply complete all parts of this form and press submit. Personal Details
Title:
Name:
Address1:
Address2:
Address3:
Postcode:
Telephone:
Facsimile:
Email:
Insurance Details
CLA Membership No:
I would be interested in
Home:
Renewal Date:
Farms Or Estate:
Renewal Date:
Business:
Renewal Date:
Motor:
Renewal Date:
Other Insurance:
Please give details:
I currently generate energy from renewable sources:

Data Protection Act:
The personal details you supply for this prize draw will be used for the purposes of contacting you prior to your insurance renewal, with a view to providing you with a "no obligation" premium indication. If this is of interest, we will subsequently provide a full quotation (subject to receipt of a satisfactory proposal form) before arranging cover. The personal details supplied will not be made available to any third party other than for administration and/or outsourced services, or where permitted by law. Your details may be used by R K Harrison Insurance Services Ltd for mailing you with further information about our services. If you do not wish to receive further information, please tick this box

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