OECD Tag Order Form

After filling in the appropriate fields below, print this page for your records
before clicking the "submit" button.

If you have not received confirmation within 24 hours, please contact Illinois Crop
at 217-359-4053. When calling, please specify the type of request you initiated
(Tag Order, Certificate Order, Contact Us).

Fields marked with * are required.

Company : *

Email : *

Location : *

Variety : *

Crop : *

Class : *

Name of person placing order :

Phone number of person placing order :

Year & location grown : *

OECD Reference number :

(issued by IL Crop)

IL Crop test # (if known) :

Sheller/unclean

clean/graded

IL Crop field # :

Producer or conditioner # :

Not Finally Certified (Grey Tag) :

Net weight or kernel count of each bag/container : *

Total weight of tag order : *

lbs.

Date sealed (month & year) : *

Lot# : *

Basic seed :

Country of Production

F-

M-

Lot # (not pedigee)

F-

M-

Treatment (type and amount) : *

Destination of seed : *

Number of Tags : *

Sew on

Stick on (OECD Certified only)

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If you have questions, please contact:

Illinois Crop Improvement Association
Tags & Records
Attn: Diane Campbell
Phone 217-359-4053 ext 19
Fax 217-359-4075
e-mail: dcampbell@ilcrop.com