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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