Spray Order Form Spray Order Form Client Name * Farm No/Property Name * Postal Address Booking Date * Ready now Not yet ready (choose a date) Choose a date Email Address * Mobile Number * Contact Name * Order details FIELD NO CROP * HA * Water rate * Table CHEMICAL * RATE * Add Remove To ensure accuracy of this information, all neighbours with land adjoining or in proximity to the proposed treatment area should be consulted before answering the following questions: Please tick appropriate box: 1. Will field workers and neighbouring workers be present? Yes No 2. Has a map showing the fields and surrounding areas been provided? Yes No 3. Are there any special considerations for any of the following? Susceptible crops (including your neighbours crops) Bees/ Organic Farms Pastures and Grasslands (including your neighbours property) Houses (permission is required if within 150m of treatment area) Roads and Stock Routes Grazing Stock Channels, Drains and Waterways Power Lines School Buses If you have ticked any of the above please give details Attach Map Drop a file here or click to upload Choose File Maximum upload size: 5MB Attach Rec Drop a file here or click to upload Choose File Maximum upload size: 5MB If you are human, leave this field blank. Submit Δ
