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
Day
Month
Year
5
Number of $25 Packs Required* This field is required.
6
Halal Meat* This field is required.
YESNO
7
Frequency of Order
"One Off"
Weekly
Fortnightly
Monthly
8
Total Cost of Order in $ (NZD)
9
Payment Information

Meat Packs are priced at

$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
10
Online Payment* This field is required.Please note this is for our record only, you will NOT be prompted to make payment now
YESNO
11
Additional Notes for Order (Optional)
Should be Empty: