2024 Performance Guarantee Claim Form

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Please use the form below to submit your claim for the 2024 season.

"*" indicates required fields

Please use the form below to submit your claim for the 2024 season.

Name*

First Last

Farm Name*

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Preferred Retailer (Replacement product shipping address. Must be a physical address.)*

Street Address Address Line 2 City State ZIP Code

Claim Details

Land location of fields under claim (If you need to make a claim for an additional field, please submit a separate claim for each field.)*

Crop Species*

Crop Variety*

Preceding Crop in Rotation*

Acres Under Claim (treated Envita acres that did not provide minimum yield guarantee)*

Total Envita Purchased*

Yield of Treated Acres (bu/ac)*

Acres of Check Area*

Yield of Untreated Check Acres (bu/ac)*

Method Used to Collect Data*

Other than Envita, was the management of the fields the same?*

Planting Date*

Envita Application Date*

Harvest Date*

Method of Envita Application*

Growth stage at application (i.e. V2, V3, V4, V5, V6, VT)

Applied Water Volume (gal/ac)*

What was tank mixed with Envita?*

Please list all that apply

Amount of actual nitrogen (lbs/ac) applied?*

Field Soil Type - Best Description*

Type of Year*

Estimate of Rainfail (inches)*

Proof of Purchase* (REQUIRED)

Drop files here or

Accepted file types: pdf, jpeg, jpg, gif, png, Max. file size: 1 GB, Max. files: 5.

Please provide proof of purchase

Yield Monitor Data

Drop files here or

Accepted file types: jpeg, jpg, gif, png, pdf, doc, Max. file size: 1 GB, Max. files: 5.

Please provide yield monitor data

Crop Pictures

Drop files here or

Accepted file types: jpeg, jpg, gif, png, pdf, doc, Max. file size: 1 GB, Max. files: 5.

Please provide crop pictures if possible