. Call us - +27731772941
. Please complete the Farm Questionnaire below
.
. Your name:- -
. Your email:- - view Privacy Policy (opens in new page)
. Farm name:- -
. Farm GPS:- -
. Local Municipality:- -
. Number of farm labour houses:- -
. Number of farm labourers / occupiers:- -
. Source of water (check one):- - Borehole
.   - Dam
.   - Municipal
.   - River
.   - Well
.   - Other
. If other, specify:- -
. Has water been tested to be potable?:- - Yes
.   - No
.   - Don't know
. Distance to water point:- - less than 200m
.   - 201m - 500m
.   - 501m - 1,000m
.   - 1km - 2km
.   - 2km - 3km
.   - more than 3km
. Ablution facilities:- - In dwelling toilet and shower/bath
.   - In dwelling toilet only
.   - In dwelling shower/bath only
.   - Outdoor toilet and shower/bath
.   - Outdoor toilet only
.   - Outdoor shower/bath only
.   - Communal toilet and shower/bath
.   - Communal toilet only
.   - Communal shower/bath only
.   - Bush toilet and shower/bath
.   - Bush toilet only
.   - Bush shower/bath only
.   - No facilities
. If other, specify:- -
. Refuse removal service:- - Farm service
.   - Municipal service
.   - No service
.   - Self service
. Comments:- -
. Security Code:- -
Case sensitive
. -
. -