Aerial Application Job Order

Client

Property

Date

Date Required

Priority

Field & Chemical

Field Name/No

Product 1

Rate

Product 2

Rate

Product 3

Rate

Wetter

Rate

Water Rate

Have you notified your neighbours?

Are there any occupied dwellings within 150m of the treatment area? If yes we require written permission

Are there any special considerations for any of the following:

Susceptible Crops (including neighbours crops)

Please Provide Details

Grazing Land/Grazing Stock

Please Provide Details

Pastures

Please Provide Details

Rivers and Channels (especially drainage)

Please Provide Details

Houses/Gardens

Please Provide Details

Aquatic Farms/Dams/Waterways

Please Provide Details

Roads/Stock Routes

Please Provide Details

Fences

Please Provide Details

Trees, in particular dead limbs

Please Provide Details

Power Lines

Please Provide Details

Bee Sites

Please Provide Details

Flora/Fauna

Please Provide Details

Organic Farms

Please Provide Details

Workers/Contractors

Please Provide Details

Towns

Please Provide Details

Are there any other environmental considerations or special instructions?

Please Provide Details

I hereby declare that all the information provided in this spraycheck list is complete, true and correct, and that I have read and understand the terms and conditions.

Name

Date Accepted

Email Address (used to send order confirmation)