Print this form, fill in the requested details and post it to the address at the bottom of the form. This form has been formatted to print comfortably on a single A4 page. Application for inclusion in the listings on the www.HighlandServcies.info website 1. Personal details (this information will not be published on the website and will not be stored in an electronic format) Your name......................................................................... Your Company / Organisation name ................................................. Your postal address............................................................... .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. 2. Details to be published on the website Enter here the information you wish to be included on the listings on the website, exactly as you want it to be shown. (this information will be stored in an electronic form) Company / Organisation name ..................................................... Company / Organisation telephone number .......................................... Company / Organisation address ................................................... .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. Company / Organisation activity or description (continue on back of form if needed) .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. Company / Organisation email address ............................................. Company / Organisation web site ................................................. Data protection act declaration. I hereby consent to all the information provided by me in section 2 of this form being stored in an electronic format and being published on the www.highlandservices.info website and hence becoming public information available to be viewed by anyone. Signed ........................... 3 Payment details. Enclose a cheque for �2.50 payable to D.G.Hewitt to cover the administration costs of adding an entry (�1 if for changing an existing entry) 4 I request the details shown on this form to be published on highlandservices.info website and I agree to the terms and conditions shown on the website. I enclose a cheque for amount �...... payable to D.G.Hewitt. Signed ............. 5 Send completed form with cheque payable to D.G.Hewitt to: 1 Stadhampton Road, Drayton St Leonard, Wallingford, Oxon, OX10 7AR.