Harvista™ Treatment Order Form

Please complete the form below to request a treatment.

CUSTOMER DETAILS

Please enter your details.

Client Name / Payer:

Sold To Address:

Email Address:

Customer Contact No:

Contact Person:

Ship To / Delivery Address:

VAT No:

APPLICATION TYPE

Please select your preferred application type.

Self application

Service model (minimum of 1,8ha)

LOCATION DETAILS

Please enter the farm details.

Region:

Ceres

Grabouw / Elgin

Vyeboom/ VilIiersdorp

Langkloof

Other

Other Region (please specify):

ORCHARD DETAILS

Please enter the orchard details seperately for each orchard.

ORDER #1

Please enter the details for Order 1.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #2 - if necessary / applicable

Please enter the details for Order 2 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #3 - if necessary / applicable

Please enter the details for Order 3 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #4 - if necessary / applicable

Please enter the details for Order 4 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #5 - if necessary / applicable

Please enter the details for Order 5 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #6 - if necessary / applicable

Please enter the details for Order 6 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #7 - if necessary / applicable

Please enter the details for Order 7 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #8 - if necessary / applicable

Please enter the details for Order 8 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #9 - if necessary / applicable

Please enter the details for Order 9 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

ORDER #10 - if necessary / applicable

Please enter the details for Order 10 if required.

Farm Name:

Orchard Number:

Size of Orchard Area requiring Application (ha):

Row Width:

Fruit Type:

Apple Cultivar:

Pear Cultivar:

Other Fruit Type:

Other Cultivar:

Total Area Requiring Application:

Harvista™ Treatment Order Form

CUSTOMER DETAILS

APPLICATION TYPE

LOCATION DETAILS

ORCHARD DETAILS

ORDER #1

ORDER #2 - if necessary / applicable

ORDER #3 - if necessary / applicable

ORDER #4 - if necessary / applicable

ORDER #5 - if necessary / applicable

ORDER #6 - if necessary / applicable

ORDER #7 - if necessary / applicable

ORDER #8 - if necessary / applicable

ORDER #9 - if necessary / applicable

ORDER #10 - if necessary / applicable

Total: ha