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Priority Partnership Membership Application
To apply to be a member of Priority Partnership, please complete the form below and click the Submit Application button.
Salutation:
Mr
Mrs
Ms
Miss
Surname:
*
Firstname:
*
Farm/Business Name:
Farm size:
(hectares)
Phone:
Mobile:
Fax:
Email:
Postal Address
Road/Street/PO Box:
*
Suburb/RD:
Town/City:
*
Postcode:
*
1.
Your main farming activity:
Select...
Sheep & Beef
Contractor
Dairy
Deer
Horticulture
Crop & Livestock
Cropping
Kiwifruit
Market Gardener
Stone fruit
Other
Pip fruit
Grape grower
*
Type:
2.
Your second farming activity
(if any)
:
Select...
Sheep & Beef
Contractor
Dairy
Deer
Horticulture
Crop & Livestock
Cropping
Kiwifruit
Market Gardener
Stone fruit
Other
Pip fruit
Grape grower
Type:
3.
Adult livestock numbers
(approximate)
:
Sheep:
Dairy:
Beef:
Deer:
Other:
4.
Would you like your statement:
No
Yes
Confirm Email:
*
5.
Preferred rural supplier:
Please include branch and/or town: E.g. PGG Wrightsons, Hamilton
Preferred rural supplier 1:
*
A/c No:
*
Preferred rural supplier 2:
A/c No:
Preferred rural supplier 3:
A/c No:
Preferred rural supplier 4:
A/c No:
Preferred rural supplier 5:
A/c No:
Preferred rural supplier 6:
A/c No:
I agree to the terms and conditions
*
This information is required by Nufarm NZ to consider and, at our discretion, admit you as a member of the Priority Partnership® programme. No other party outside Priority Partnership will receive any information provided on this application form. If you choose not to provide any of the information required by this form, your application may be denied. You have the rights of access to, and correction of, any personal information provided under the Privacy Act 1993. It is important that our information about you is correct. If there are any changes to these details, please notify us.
Please allow 10 working days to process your application.
Priority Partnership® is a registered trademark of Nufarm Ltd.