formtest 1: Your Details Grower / Company Name: Farm Name: Person Placing Order Your email Phone Order Date Date/Time Required AMPM Product Supplier Airstrip Being Used 2: Application Requirements Group 1 Crop Being Treated Water volume per Ha required Paddock Details Paddock name/number Hectares in paddock Add Paddock NoYes Extra paddock 2 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 3 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 4 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 5 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 6 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 7 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 8 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 9 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 10 Paddock name/number Hectares in Paddock Product Details Product Name Rate per Ha Add Product NoYes Product 2 Product Name Rate per Ha Add Product NoYes Product 3 Product Name Rate per Ha Add Product NoYes Product 4 Product Name Rate per Ha Add Product NoYes Product 5 Product Rate per Ha Add Product NoYes Product 6 Product Name Rate per Ha Extra Group Required: NoYes ----------------------------------------------------------------------- Group 2 Crop Being Treated Water volume per Ha required Paddock Details Paddock name/number Hectares in paddock Add Paddock NoYes Extra paddock 2 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 3 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 4 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 5 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 6 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 7 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 8 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 9 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 10 Paddock name/number Hectares in Paddock Products Product Details Product Name Rate per Ha Add Product NoYes Extra Group Required: NoYes Product 2 Product Name Rate per Ha Add Product NoYes Product 3 Product Name Rate per Ha Add Product NoYes Product 4 Product Name Rate per Ha Add Product NoYes Product 5 Product Name Rate per Ha Add Product NoYes Product 6 Product Name Rate per Ha ----------------------------------------------------------------------- Group 3 Crop Being Treated Water volume per Ha required Paddock Details Paddock name/number Hectares in paddock Add Paddock NoYes Extra paddock 2 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 3 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 4 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 5 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 6 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 7 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 8 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 9 Paddock name/number Hectares in Paddock Add Paddock NoYes Extra paddock 10 Paddock name/number Hectares in Paddock Product Details Product Name Rate per Ha Add Product NoYes Product 2 Product Name Rate per Ha Add Product NoYes Product 3 Product Name Rate per Ha Add Product NoYes Product 4 Product Name Rate per Ha Add Product NoYes Product 5 Product Name Rate per Ha Add Product NoYes Product 6 Product Name Rate per Ha ----------------------------------------------------------------------- 3. Hazards Please select if any apply to the area and neighboring area being sprayed Powerlines (treatment area)Powerlines (neighboring area)RoadsRiversWaterwaysSensitive CropsOrganic Crops/FarmsBuildings / Structures within 150 metres Any additional hazards - please list here 4. Additional Requirements School Bus Noyes If Yes, what time? Are the chemicals registered for aerial application on the intended crop? —Please choose an option—YesNo Are all sensitive crops in neighboring areas noted —Please choose an option—YesNo Are there occupied home/businesses within 150m of area to the sprayed —Please choose an option—YesNo Have neighbours been informed with your aerial application intentions including products being used? —Please choose an option—YesNo Do we have a copy of all paddock maps? YesNo (If No, please mark paddock boundaries on map 5: Mark Map Boundary Mark application paddock area(s) on map Need help using the map tool click here Your message (optional) Please confirm the details entered above are all correct before submitting form
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