REGISTER BOREHOLE Fill the form belowNAME *Surname firstADDRESS *COUNRTY *STATE *PHONE NUMBER *ALTERNATE PHONE NUMBER EMAIL *BOREHOLE CONTRACTOR'S NAME *YEAR OF CONTRACT AWARD *YEAR OF CONTRACT COMPLETION *IS BOREHOLE WORKING PRESENTLY? *YESNO VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank: