OKLAHOMA CROP IMPROVEMENT ASSOCIATION

ORDER FORM FOR CERTIFICATION LABELS

Date Date / MM / DD YYYY
Name Name First Last
Email
Shipping Address Shipping Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
OK Seed License #
Variety
Crop
Lot#
Mechanical Purity %
Germination %
Cert. #
Inert Matter %
Hard Seed %
Seed Count/lb
Other Crop Seed %
Test Date (mm/yyyy)
Weed Seed %
Origin
Noxious Weeds
Test Wt. (Cert. only)
Bulk

Bulk Yes
Bagged

Bagged Yes
Wt/lb
Type of Tag

Type of Tag Sew On Pressure Sensitive
Certified
Registered
Foundation
Check here if

Check here if Seed is Downgraded
Comments/instructions
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