Customer form

Company details

Organisation Specialism:  Cattle   Poultry   Sheep   Goat   Pig   Horse   Pet   Anders

Are you certified to receive/deliver animal medicines?*  Ja   Nee  

Please supply supporting document (wholesalers licence, vetrinary diploma).

Number of practicing vets:

Visitor address

Delivery address (If different from above)

Invoice Address (If different from above)

Order contact

Invoice contact (If different from above)

Quality contact (If other than above)

How did you hear about Kernfarm?

 I accept the terms & conditions & privacy statement.*

Terms & conditions (PDF)
Privacy statement EN (PDF)

*verplicht veld

“We strive to continually improve the product portfolio
and service Kernfarm offers”

- Diederik -

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