Donate on your Farmlands Card

Details

First Name:

Last Name:

Email Address:

Phone Number:

Farmlands Shareholder Number:

"D" on the diagram below

Donations

Donation Amount ($):

Please select... 5.00 10.00 20.00 30.00 40.00 50.00 75.00 100.00 150.00 200.00 300.00 400.00 500.00 1000.00 Other

Other donation amount ($): 

Terms and Conditions

I agree to the donation total being charged to my shareholder Account.