Question Title * 1. Please enter your details Full Name Phone Number Email Address Question Title * 2. Farm name Question Title * 3. Farm address City State Question Title * 4. Have you made any FLEXadvantage purchases recently? Yes No Question Title * 5. Please upload proof of purchase PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload proof of purchase Question Title * 6. Please tick below By ticking the box, I consent for Boehringer Ingelheim Animal Health Australia Pty Ltd ("BIAH") to collect and use the personal information provided by me in this form, for the purpose of conducting the promotion and for the purpose of sending me promotional and marketing communications in the future. I understand that such information collected will be used, stored and disclosed in accordance with BIAH's Privacy Policy. By ticking this box, you agree to receive marketing, advertising and promotional information. Done
