NEW CUSTOMER FORM

Questions To Help Us Serve You Better and Faster

Please help us provide faster personalized consultations by filling out this form below

Please complete as much possible

Fields with an * indicates Required Information.

 

Your Name *

Address *

City *

State *

Zip Code

Home Phone

Cell Phone

Fax

Your Email (required)

Best Hours to Contact You

Contact #2 Name

Contact #2 Phone

Any Special Contact Notes


Your Preferred Payment Method - Note: All first time orders will be COD or credit card. Subsequent order will use your preferred payment method.
CheckCODCredit CardACH


How Did You Here About Us?
Cattle ConnectionFarm ShineAgri-ViewAG NewsletterCountry FolksCountry TodayWI Holstein NewsAmerican DairymanProgressive DairymanWebsiteAgribusiness DairymanOther

If Other Above


Goals/Problems/Notes

Current SCC

Who Does the Feeding

How Often

Who Does Veterinary Treatments?

Total Number of Cattle

Number Milking

Number of Milkings Per Day


Breed of Cattle
HolsteinJerseyAyshireBrown SwissCrossbreedOther


Milking
ParlorConventional


TMR
YesNo


DHIA
YesNo


Cement Tank?
YesNo


Uses A/I?
YesNo


Do You Have A CD/DVD Player?
YesNo


Other Notes

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