DWWA ENTRY FORM SUBMITTER DETAILS - PAGE 1


1. SUBMITTER COMPANY NAME Company Name House Number / Name Street


Address Line 3 Town


County/Region


Country Telephone Email


Type of Company c Producer c Agent


2. MAIN CONTACT AT SUBMITTER COMPANY Contact Title (Mr/Mrs/Ms/Miss)


Name Contact Tel/ Mobile Contact Email


DATA PROTECTION: Decanter, published by IPC Media Ltd (IPC), will collect your personal information to process your entry. Use of entrant’s email address: When you enter this competition, your email address will be added to the monthly Decanter World Wine Awards newsletters. However, you will be given the opportunity to unsubscribe from the email newsletters via the unsubscribe message in the email.


• Would you like to receive emails from Decanter and IPC containing news, special offers and product and service information and take part in our magazine research via email? Yes / No. • Decanter and IPC would like to contact you by post or telephone to promote and ask your opinion on our magazines and services. Yes / No. • IPC may occasionally pass your details to carefully selected organisations so they can contact you by telephone or post with regards to promoting and researching their products and services. Yes / No


3. UK AGENT DETAILS c Yes Do you have a UK agent?


3A. UK Agent Contact Name


UK Agent Company UK Agent Address Line 1 UK Agent Address Line 2 UK Agent Address Line 3


UK Agent Tel UK Agent Email


4. HOW MANY WINES ARE YOU ENTERING? No. of Wines Samples sent from the UK in Pounds (GBP £) £98.00 + VAT (20%) per wine


Samples sent from outside of UK in Pounds (GBP £) £114.00 + VAT (20%) per wine Samples sent from outside of UK in Euros (€)


€135.00 + VAT (20%) per wine


Samples sent from outside of UK in US Dollars (USD $) $172.00 + VAT (20%) per wine Wines entered into the DWWA Tasting, London


£35.00 + VAT (20%) per wine TOTAL 5. VAT


If your company is based in the EU and you provide a valid VAT number, you will be VAT exempt. VAT Country Code:


VAT No.


If you are based outside the EU or cannot provide a VAT number, you must include the 20% VAT charge per wine in your payment. PLEASE ENSURE YOU HAVE COMPLETED BOTH SIDES OF THIS FORM - PAGE 1 0F 2


EN


£ £ € $ £


Cost c No If YES, please complete section 3A.


If NO, and you are looking for a UK Agent, please complete section 15 on page 2 of the Wine Details Form to ensure that you are contacted about the Unsigned Talent Tasting should your wine win a medal.


Postcode / Zip Code Fax Website c Importer/Distributor c Retailer


SUB (for office use)


Postcode UK Agent Website


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