Fern Energy Enquiry Form
Contact Details
Contact Name
eg. John Smith
Contact Phone Number
Contact Email address
Contact Address
Are you a Farmlands Shareholder?
Please select...
Yes
No
Account Number
9 digit number on the bottom left of your Farmlands Card
Account Name
Fuel Information
Current Fuel Supplier?
Please select...
Allied
Farm Source
KL Distributions
McFalls
McKeowns
NPD
RPD
Rural Co
Toll Wellans
Waitomo
Fill Rural
Service Station
New to Bulk
Fern
Other
Other
Industry of Business?
Please select...
AGG Contractor
Ag/Farming
Forestry
Marine/Aquaculture
Horticulture
Small Commerical
Earthworks
Vitaculture
Transport
Reseller
Other
Other
Requirements
I am interested in knowing more about?
Bulk Fuel Delivery
Fuel Tanks
Lubricants & Oil
Additional Information
Farmlands Referrer Name
Contact Information