Customer Form

Customer No.

Mr. Mrs. Other

First name, Last name

Farm Name, Account

Rd, Street

City / Town, Dairy No.

Telephone, Cell Phone

E-mail

Sharemilker

Telephone, Cell Phone

Insert your farm map here

Fertiliser Forecast

Fertiliser (A)

Tonnes

Rate (Kgs)

Month – Due Date

Fertiliser (B)

Tonnes

Rate (Kgs)

Month – Due Date

Fertiliser (C)

Tonnes

Rate (Kgs)

Month – Due Date

Merchant

The orders are split in charge or delivery

Miscellaneous

Further, relevant information.

Please...

... The merchant order(s) have been placed

... I will fax you a copy of the farm map

... Contact me by phone for confirmation

... Contact me by e-mail for confirmation

... I proactive in my farm plan for the future

... send me your newsletter

Click 'Submit' To Send

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