Purchase Agreement Form - Ministry Of Agriculture

Purchase Agreement Form - Ministry Of Agriculture - 2016 Page 2

Ministry of Agriculture

PURCHASE AGREEMENT FORM - 2016

Page 2

A SEPARATE FORM MUST BE COMPLETED FOR EACH PURCHASE OF 2%LSC. ORIGINALS ARE TO BE KEPT AT THE RM OFFICE.

PURCHASE INFORMATION (*Required Fields)

*Rural Municipality of

No.

*Date of Purchase:___________________

*Name:______________________________

*Telephone #:(

)

(please print)

*Mailing Address or P.O. Box #:

*City, Town or Village:

*Postal Code:

E-mail address:_____________________________________________

*Amount purchased:

(# of bottles)

TREATMENT PLAN (*Required Fields)

*Location of the land to be treated (for multiple sites, only list the site with the highest infestation):

Quarter

Section

Township

Range

Meridian

or GPS Coordinates:

Farm Size:

(acres)

*Estimated acres to be treated:

Crop (crop type)

Acres Treated

Forage

Acres Treated

Pasture

Acres Treated

CERTIFICATION

As the RM Administrator (or designate), I certify that the information provided on the form, to the best

of my knowledge, is accurate.

RM Administrator Name:

RM Administrator (or designate) Signature:

Purchase Agreement Form - Ministry Of Agriculture - 2016 Page 2