CUSTOM ORDER FORM To receive a quote, fill out this form and click the submit button at the end of the form. We will get back to you as soon as possible. CUSTOM COATED SEED TRANSMITTALCustomer*Date*PO Number*Name*Phone*Email* Raw Seed InformationSpeciesVarietyLot NumberSeed CountTreatedLabeled GermProducerQty. of Raw SeedOrder InformationConventional FILM COAT GRO-COAT Pre-Prep Prep-Coat Prep-Coat Special Light Density Medium Density Medium Density-D Heavy Density Treatment Thiram ProGro Trigard FarMore F-300 FarMore FI-400 FarMore FI-500 FarMore OI-100 NipsIt Organic PULSE Gro-Coat PULSE Pre-Prep PULSE Prep-Coat D Pellet (brown) Other ConventionalOther TreatmentOther OrganicFilm/Blaze ColorBelt SizeAirMaxx (encrusted)Packaging InstructionsNo. of Units per PackagePack in LbsSDI CartonsSDI PailsOtherSpecial Labeling InstructionsItem 1Item 2Item 3Shipping InstructionsRequest Ship DateShip ViaBilling Acct NumberShipping AddressCityStateZipAdditional Comments or InstructionsWaive Suitability TestingProcess While in TestEmailThis field is for validation purposes and should be left unchanged.