Planting/Spraying Form

• First Name *
• Middle Initial
• Last Name *
• Email *
• Farm/FSA#
• Farm Name
• Date

Corn

• Field Acres (to tenths)
• Date Planted
• Variety
• Population
• Row Spacing

Pre-Plant or Pre-Emergence Spraying

• Applicator Name
• Cert #
• Application Date
• Chemical Name
• Rate
• Total Amount Applied
• Chemical Name
• Rate
• Total Amount Applied
• Additives
• Application Type (PPI PE Band or Broadcast)
• Weather Conditions (wind, temp, etc.)

Corn Insecticide Information

• Applicator Name
• Cert #
• Chemical Name
• Rate
• Date Applied
• Acres Treated
• Total Amount Applied

Soybeans

• Field Acres (to tenths)
• Date Planted
• Variety
• Population
• Row Spacing

Pre-Plant or Pre-Emergence Spraying

• Applicator Name
• Cert #
• Application Date
• Chemical Name
• Rate
• Total Amount Applied
• Chemical Name
• Rate
• Total Amount Applied
• Additives
• Application Type (PPI PE Band or Broadcast)
• Weather Conditions (wind, temp, etc.)

I have reviewed and confirmed all information is correct prior to submitting this form.