* Indicates a required field
First Name: *
Last Name: *
Email: *
Address 1: *
Address 2:
City: *
State: *
Zip Code: *
Phone: *
  I am 21 years of age or older.*
 yes no
 
Which of the following fungicides did you use in 2004?*
 

STRATEGO® fungicide
GEM® fungicide
Quilt™
Quadris®
Tilt®
Other

Do you use a consultant to help select your materials?*
 

Yes
No
Who MOST influences your rice fungicide purchase decision? *
 

Dealer
Consultant
Extension/University Specialist
Others

What is the business name of your primary ag retailer?
Retailer City?
Retailer zip?
Retailer phone?
Retailer state?
Yes, I would like to receive future promotional material and special announcements from Bayer CropScience.
Yes, I would like to receive a FREE trial issue of Progressive Farmer magazine.
 

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