AES-08-57 SEED SAMPLE SUBMISSION FORM

SEED SAMPLE SUBMISSION FORM
CONTACT INFORMATION
Company or Individual Name
Contact Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Date Sample Submitted

MonthDayYear
Telephone Number
Enter only numbers
Bill Testing Fees to (if different than mailing address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NOTE: Do not send payment with sample. Testing service fees will be billed to the address given above. You may remit payment by check or pay through our online services website.
Seed Kind:
Variety if known:
Lot or ID number:
Carry Over Seed:

YesNo
Year Grown:
Will test be used for seed labeling or relabeling purposes?

YesNo
Treatment Used
Indicate the tests you require on the sample:

List of seed testing fees can be found at http://ldaf.la.gov
Purity Test:

Standard Purity, including LA Noxious Weed SeedRed Rice CheckSeed ID only (physical examination)All-State Noxious Weed Seed ExamBulk Exam
If requesting the All-State Noxious Weed Seed Exam, please specify states:
If requesting the Bulk Exam, examination requested for the following impurities:
Germination Tests:

Standard GerminationTetrazolium (TZ)Soil Germination
Vigor Tests:

Accelerated AgingTexas Cool TestCold Test
Other Tests:

Varietal PuritySeed CountFluorescence Test (Ryegrass/Oats)
Additional Services (choose all that apply):

Rush (Additional $25.00 per sample. Sample will be prioritized and process upon receipt.Sample collected by LDAF Inspector (Additional $15.00 per sample. Sample will be collected according to AOSA guidelines.)I prefer to view my analysis report online (Note: You must be a registered user to access the online service. To register, contact our office by email at: seed@ldaf.state.la.us.)Other
Comments
Once you click submit, you will receive a confirmation email with your responses. Please include a copy of that email with your seed samples.

Mail Samples to:

LDAF State Seed Testing Laboratory, 5825 Florida Blvd., Suite 3004, Baton Rouge, LA 70806
Should be Empty:

SEED SAMPLE SUBMISSION FORM

CONTACT INFORMATION

Indicate the tests you require on the sample: