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2025 Performance Guarantee Claim Form - USA
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This field is for validation purposes and should be left unchanged.
Please use the form below to submit your claim for the 2025 season.
Name
*
First
Last
Farm Name
*
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Preferred Retailer (Replacement product shipping address. Must be a physical address.)
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
*
Yield Monitor
Weigh Wagon
Other than Envita, was the management of the fields the same?
*
Yes
No
Planting Date
*
MM slash DD slash YYYY
Envita Application Date
*
MM slash DD slash YYYY
Harvest Date
*
MM slash DD slash YYYY
Method of Envita Application
*
Foliar
In Furrow
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
*
Clay
Silty Clay
Silt Loam
Loam
Sandy Loam
Sand
Type of Year
*
Wet
Dry
Normal
Estimate of Rainfail (inches)
*
Proof of Purchase* (REQUIRED)
Drop files here or
Select files
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
Select files
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
Select files
Accepted file types: jpeg, jpg, gif, png, pdf, doc, Max. file size: 1 GB, Max. files: 5.
Please provide crop pictures if possible
Other Questions or Comments
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