Ph: (02) 6754 3599

Aerial Application Order

CLICK HERE for a printable version of the form which can be faxed.

PHONE No:	02 67 543599	FAX:	02 67 543598	MOBILE:	0438 543599
Name:		Email:
Received On:		Date Req:		Time Req:
Client:		Order No:
Property:		Phone No:		UHF No:
Ordered By:		Mobile No:		Fax No:

Field Numbers	HA	Product	Rate	Total Volume	Product Required

I UNDERSTAND THAT THIS FORM DOES NOT CONSTITUTE A BINDING CONTRACT AND DOES NOT OBLIGE RURAL AIR WORK PTY LTD TO CARRY OUT THE REQUESTED APPLICATION.

PLEASE PHONE TO CONFIRM THAT YOUR FAX HAS BEEN RECEIVED

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Product Supplier:	Crop:
Please Tick Appropriate Box:
1. Will chippers or field workers be present?	Yes	No
2. Have chippers and field workers been Notified?	Yes	No
3. Your neighbors need to be Notified. Have you done this?	Yes	No
4. Will your neighbors have field workers present?	Yes	No
5. Are there any special considerations for any of the following?	Yes	No
Susceptible crops	Yes	No
Pastures	Yes	No
Houses	Yes	No
Roads	Yes	No
Stock routes	Yes	No
Grazing stock	Yes	No
Grazing land	Yes	No
Rivers	Yes	No
Waterways	Yes	No
Fences	Yes	No
Power wires	Yes	No
6. If you have answered "yes" to any of the above, please give details:
7. Are there any other environmental considerations or special instructions?