New Client

This form is used to capture new Client data by an agent. This data will be sent to Ecofarm Aotearoa, The Agent and the Client

Enter Client Details (Biz name, billing etc)

Client Name:
Client Email:
Company:
Address:
Town:
State:
Phone:
Mobile:
Postcode:

Property Size
Is testing address same as above

Enter address for testing if different from above

Testing Address:
Testing Town:
Testing Post Code:

Land/Farm Type

Tests Required
Land area for testing

By what date would the client like tests completed

Other notes:

 
 
 
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