HELISPECS AERIAL APPLICATION ORDER
CUSTOMER NAME:
ABN:
ADDRESS:
STATE:
POSTCODE:
CONTACT PERSON:
PH #:
MOBILE PH #:
EMAIL:
UHF CH:
DATE OF ORDER: REQUIRED DATE:

Prescription supplied by Agronomist.

Agronomist Name:

Attach Prescription

Attach Map

Attach Kml

PADBOCK BLOCK HA,s CROP TYPE WEED/PEST WIND REQUIRED CHEMICAL/FERTILISER PRODUCT BATCH # APP RATE HA TOTAL USED WATER RATE/HA
PADDOCK BLOCK HA,s CROP TYPE WEED/PEST WIND REQUIRED CHEMICAL/FERTILISER PRODUCT BATCH # APP RATE HA TOTAL USED WATER RATE/HA

Customers agrees to pay account within 14 days from invoice date.

CHEMICALS REGISTERED FOR USE & APPLICATION BY AIR?

Aircraft approved to fly within 100m of dwellings (including Neighbours)?

I understand the safety brochure that accompanies this Order

Susceptible Crops nearby? (Including all neighbours) Houses, Roads, Bees,

School Buses, Organic Farms, Aquaculture, Waterways, Vineyards, Others?

POWERLINES, WIRES, TOWERS, MASTS (MARKED ON MAP)

MAP(A4) IDENTIDIED SUSCEPTIBLE CROPS / HAZARDS / POWERLINES, WIRES

Please provide additional application details:

All the above information supplied is accurate, & by submitting this order. I agree to the Helispecs Aviation Pty Ltd Terms & Conditions attached to this Aerial Application order.

NAME:
POSITION: DATE:

FOR AERIAL APPLICATION TO PROCEED THIS ORDER MUST BE COMPLETED & ACCOMPANIED BY AN A4 MAP IDENTIFING ALL SUSCEPTIBLE CROPS, HAZARDS AND WIRES

View Terms & Conditions / Safety Brochure