WYOMING SEED ANALYSIS LABORATORY

749 Road 9, Powell, WY 82435         307-754-4750

 

Please complete this section if you are a new customer or if information has changed.

Contact Person:______________________________

E-mail:_____________________________________

Fax:_______________________________________

Phone:_____________________________________

Address:________________________________________________________________

 

 

Sample information:

Sample submitted by:__________________________

Species:_____________________________________

Variety:_____________________________________

Lot #:_______________________________________

Is this a certified seed lot?  Yes___  No___  Certified lot number:___________________

Sample treated? Yes___  No___  Treatment used:________________________________

Sampled by:__________________________________

Bill testing fees to (if different):______________________________________________
                                                   ______________________________________________

                                                   ______________________________________________

Please indicate the tests you require on the sample:

____Germination

____Purity

____Noxious (circle one): WY, All States, Western*, AZ, CA, CO, ID, MT, ND, NM,  NV, OR,   SD, WA, Other________*Western includes AZ, CO, ID, MT, NE, ND, NM, NV, OR, SD, UT, WA, WY

____TZ

____Seed Count

____Moisture

____Clearfield Bioassay

____Other:___________________________________

 

Please indicate services you require on the sample:

____Rush               ____Fax          ____Phone       ____Other_______________________

____Send additional report copies to:      E-mail:__________________________________

Fax:____________________________________

Address:_________________________________

              _________________________________

              _________________________________

 

10/07