Robertsons Dairy New Customer Enquiry Form Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address* Phone Number*What products are you interested in? Select All Glass bottled milk (pint) - 75p Glass bottled fruit juice (pint) - £1.20 Cheddar Cheese 350g - £3.00 Single Cream - £1.30 Double Cream - £1.60 Butter (Salted) - £1.50 Butter (unsalted) - £2.50 Morning Rolls (white) - 28p each Morning Rolls (brown) - 32p each Free Range Eggs - £1.30 Potatoes 4kg - £4.75 Bag of kindling - £4.00 Bag of logs - £5.00 Bag of rock salt - £5.75 Pints of Milk Required (please specify green and/or blue)Pints requiredPints of Fruit Juice RequiredPints requiredQuantity of Cheese (350g each)Cheese requiredPlease note: we will be in contact to discuss your order and quantities of all other products required. Thank you.Select Delivery Frequency Perth Area (Wolfhill, Kinrossie, Balbeggie, Scone, Perth, Guildtown & Murthly) - Tuesday / Thursday / Saturday. All Other Areas - Monday / Wednesday / Friday * Monday Tuesday Wednesday Thursday Friday Saturday Authorise Direct Debit - Our Variable Direct Debits are collected weekly. I confirm I would like to proceed and authorise Robertson's Dairy to set up weekly direct debit. Your delivery days and first direct debit date will be e-mailed to you by one of our team. Please note: The direct debits are taken a week in arrears. If there is a delay in setting up your direct debit, your first payment will be for the balance up to and including the previous weeks deliveries, and ongoing payments will be taken weekly thereafter.Your Sort Code (6 digits)*Your Account Number (8 digits)*Please enter your bank name*Consent* I agree to the privacy policy.How did you hear about us?* Facebook Instagram Friend/Family Newspaper Canvasser Other NameThis field is for validation purposes and should be left unchanged.
