Please complete and submit the following form to make your donation towards the formation of the Southern Dairy Hub If you are human, leave this field blank. I wish to make the following donation: * Gold Pledge (More than $10,000 specify below) Gold Pledge $10,000 Silver Pledge $5,000 Bronze Pledge $2,000 Other (Please add amount below) Pledge Amount if "Other": My Gold Pledge is in excess of $10,000 and it is: Methods of Donation: Here are your options for making your donation: CHEQUE: After submitting your form, make your cheque payable to Southern Dairy Development Trust and post to: Southern Dairy Hub Donation Fund, McIntyre and Dick, 160 Spey St, Invercargill, 9840 DIRECT CREDIT THROUGH ONLINE BANKING: After submitting your form, please make your deposit to: 03-1750-0491229-01. Include your name in the 'particulars' field, and your Supply No in the 'reference' field. CASH PAYMENTS OVER TIME: Complete and submit this Pledge form and give us a call to arrange periodic payments. CULL COWS: Complete and submit this Pledge form and detail the name of your processor and we will do the rest. FONTERRA FARM SOURCE ACCOUNT OR FARMLANDS ACCOUNT OR PGG WRIGHTSON ACCOUNT: Complete and submit this Pledge form noting your Farm Account (Fonterra Farm Source or Farmlands or PGG Wrightson) and we will do the rest. Select Method of Donation: * Cheque Direct Credit Cash Payments Cull Cows Fonterra Farm Source Account or Farmlands Account or PGG Wrightson Account Farm Supply Number * Information Full Name * Farm Account: Select either Fonterra Farm Source or Farmlands or PGG Wrightson Fonterra Farm Source Farmlands PGG Wrightson Shareholder Account Name Farmlands Account Number Your Details Name (To go up on plaque and for acknowledgement purposes) * Postal Address Address 1 * Address 2 Suburb Post Code * City * Contact Details Phone * Email * Any other information or comments: I have have read and accepted the Terms and Conditions * Yes
