LPF AgriBusiness: Request of Coop data

Request of Coop data

Dear

Herewith I,

Name *
Surname *
Tel *
Fax
Cell
E-Mail *

request that you please send my electronic financial data to LPF Systems CC at coops [at] lpfsystems.com. The use of the data is for myself, LPF Systems CC and my auditor only. Should my services stop at any of these parties, I will inform you in writing to stop sending my information. I indemnify you of any action that could be taken against you should I not notify you.

Please provide the information for the following accounts held with you:

Account No	Sub Account No

My auditor information:

Name
Address


Telephone
Fax
E-Mail
Contact Person

My Account No at Auditor

Thank you
Regards,

Please complete the below again for confirmation purposes:

I\'ve have read and agree to the Terms of Conditions and Terms of Service of this service and I am duly authorised to do so.

Name *
Surname *
ID No *
Company/Farm *
Company Reg No *