Submit Order – Elgin

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FREE RANGE IS A LIFESTYLE, NOT A LABEL

Order Enquiry
Name*
First Last
Phone*
Cell*
Email*
Company Name*

Please select the relevant option below:
- Food service provider
- Retail or Distributer

Current weekly usage of chicken?
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kgs
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kgs
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kgs
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kgs
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kgs
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kgs
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Other
kgs

Forecasted weekly usage of chicken?
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kgs
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kgs
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kgs
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kgs
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kgs
Cut
kgs
Cut
kgs
Other
kgs

Are you based in the Western Cape?
- Yes
- No
Do you require fresh or frozen deliveries?
- Fresh
- Frozen
- Both Fresh & Frozen
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you require deliveries to the stated address?
- Yes
- Submit an alternative address for delivery
Delivery Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you require retail punneted and pre-packaged?
- Yes
- No
Do you require bulk unpacked product?
- Yes
- No
How did you hear about Elgin Free Range Chicken?
- Existing Customer
- Google
- Social Media
- Word of Mouth
- At a retail outlet
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FOR ANY QUERIES, CONTACT US :
Head Office, Industria Rd, Grabouw, 7160
Postal Address: PO Box 1176, Grabouw, 7160
Tel: 021-859 2795

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