Clay Hills Ag
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Information for Aerial Application
Grower Info
Field Location/Info
*
Indicates required field
Grower Name/Company:
*
Grower Address:
*
Line 1
Line 2
City
State
Zip Code
Country
Grower Phone Number
*
Name of person to call if pilot has questions:
*
Number of person to call if pilot has questions:
*
Billing Name
*
Billing Address
*
Line 1
Line 2
City
State
Zip Code
Country
County:
*
Section:
*
Township:
*
Range:
*
Crop Type:
*
Bee Law (Bee Farm in the area):
*
Yes
No
If yes, how close?
*
Sensitive Crop (Organic Farm in the area):
*
Yes
No
If yes, how close?
*
Please include a pdf document of the applied field
*
Max file size: 20MB
Product To Be Applied
Product
*
Product
*
Product
*
Product
*
Product
*
Per Gallon Or Ounce Per Acre
*
Gallon
Ounce
Select One
*
Gallon
Ounce
Select One
*
Gallon
Ounce
Select One
*
Gallon
Ounce
Select One
*
Gallon
Ounce
Rate Of Application
*
Rate Of Application
*
Rate Of Application
*
Rate Of Application
*
Rate Of Application
*
Submit
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