FMC Liquid Ready Order Form

*Grower Name:
*Billing Address:
*Billing Address 2:
*Billing City:
*Billing State:
*Billing Zip Code:
*County:
*Phone:
*Cell Phone:
*Email:
*Planter Make:
*Planter Model No.:
*No. of Rows:
*Use With:

Water
Fertilizer

*Use In:

T-Band
In Furrow

*Gallons of finished solution per acre:
*Average Planting Speed:
*Retailer:
*Retailer City:
*State:
*# Corn Acres Planted:
*# Soybean Acres Planted:
*FMC Sales Rep:

Discounts

*Promo Code
Discount Amount:

Payment Method

Online

Amount:

Shipping Information

Ship to Grower (specified above)
Ship To Another Address: (specified below) All Fields are required if this option is chosen.

Growers who agree to purchase a minimum of 50 gals. of Capture LFR over a three year period are eligible to receive an instant 25% discount on Capture LRS equipment purchased through Ohio Valley Ag PLUS $40/gal rebate on Capture LFR over the 3 year period (up to a maximum of the LRS equipment cost or 100 gallons of Capture LFR, whichever is less). FMC reserves the right to bill the grower and/or withhold any rebates for this discount if the 50 gallon minimum is not met.

I Agree