Please complete this form to submit a credit authorisation request with the
Farmlands Credit Control team for any sales value at $10,000 or more.
For any enquiries please call 0800 200 600
Card Partner details
Card Partner Business Name:
Card Partner Vendor Number
Card Partner Contact Email
Shareholder details
Account Name
e.g. Smith Farm Partnership
Shareholder Number
This is the 9 digit number on the Farmlands Card
Person's Name
e.g. John Smith
Address
Credit Authorisation details
Description of Purchase
eg 2 x pallets of bale wrap
Invoice Total (including GST)
Amount being charged onto Farmlands Card incl. GST
Salesperson Name
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Contact Information
