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Grower Name:

Farm Name:

Address:

Street

City

State

Zip

Phone:

Email:

General Crop Information:

Affiliation (fertilizer supplier, crop consutlant):
Field Name:
Crop to be grown:
Crop Year:
Entire Block or Strips:	Block Strips
Typical drill blend:	- - -
Typical drill rate:	lbs/ac
Typical Topdress (urea/liquid/NH3):	- - -
Typical Topdress rate:	lbs/ac
Yield goal:
Quality goal:	High Medium Low
Irrigated or Dryland:	Irrigated Dryland
Livestock grazing:	Yes No
Shapefile boundary of field, or SST Package:

VR Application Information:

Type of Machine:
Urea / Liquid / NH3:
Make of Machine applying:
Model of Machine applying:
Make of Rate Controller:
Model of Rate Controller:
Make/Model of TASC Controller:
Make of Variable Rate Controller:
Model of Variable Rate Controller:
Opener Type:
VR Phosphorus / Seed:	Yes No

Notes / Special Requests

all information is confidential and will remain with PCM