Step 1 of 5: Account and Contact Details

If you need assistance with this form please email info@farmlands.co.nz

Account Name

Member Number

Your Name

Phone Number

Email Address

Best way to contact you?

PhoneEmailBoth

Step 2 of 5: Delivery Address

If you need assistance with this form please email info@farmlands.co.nz

Road Number/Name

Town

Rapid Number

Area

Site Contact

Phone

Delivery Instructions

Site Access Instructions (e.g. keys, keycodes)

Truck & Trailer Access

Truck Access Only (26 Tonne Twin Steer) Truck and Trailer Access (44 Tonne Twin Steer)Overhead Clearance Issues (eg powerlines, trees, bridges - if applicable)

Step 3 of 5: Delivery Requirements

If you need assistance with this form please email info@farmlands.co.nz

Diesel Tank 1

Tank No.

Tank Type

Size

Approx. Volume/Year

Quantity Required

Diesel Tank 2

Tank No.

Tank Type

Size

Approx. Volume/Year

Quantity Required

Regular Tank

Tank No.

Tank Type

Size

Approx. Volume/Year

Quantity Required

Delivery Schedule

We have regular service in most areas of New Zealand - delivery will be scheduled for our next regular run.

Date of last delivery (if applicable)

Preferred delivery frequency

Farmlands Fuel Compliance and Logistics Request