Meat Order Form

1
Name* This field is required.
First Name
Last Name
2
Contact Phone Number* This field is required.
Contact Phone Number
3
Email* This field is required.Required for email confirmation of order
example@example.com
4
Date for Order* This field is required.
Date
Year
Month
Day
Date
5
Pack Type* This field is required.
$20 PACK - 4 Cuts of Meat
$25 PACK - 5 Cuts of Meat
6
Number of $20 Packs Required* This field is required.
7
Number of $25 Packs Required* This field is required.
8
Halal Meat* This field is required.
YESNO
9
Frequency of Order
"One Off"
Weekly
Fortnightly
Monthly
10
Total Cost of Order in $ (NZD)
11
Total Cost of Order in $ (NZD)
12
Payment Information

Meat Packs are priced at

$20.00 per 4 cut pack or $25.00 per 5 cut pack

Payment can be made on collection via CASH or EFTPOS

Online banking is available -
Please make payments in advance to the below account

Pukete Neighbourhood House
BNZ Te Rapa
02-1272-0049021-00

Please use the below reference structure when making payment. This ensures we can effectively allocate incoming payments to your order!

Particulars: MEAT
Code: DATE (Date of Order)
Reference: FIRST & LAST NAME
13
Online Payment* This field is required.Please note this is for our record only, you will NOT be prompted to make payment now
YESNO
14
Additional Notes for Order (Optional)
15
Tags
[object Object]
Should be Empty: