SAMPLE INFORMATION PAYMENT GROWER INFORMATION CONSULTANTOTHER RECIPIENT FARM ID FEE TOTAL METHOD OF PAYMENT ESCROW ACCOUNT ONLY To pay with credit card you MUST use online sample submission

LAST NAME FIRST NAME LAST NAME FIRST NAME ADDRESS in NC where samples were collected ADDRESS SAMPLE DATE CITY STATE ZIP NC CITY STATE ZIP NC COUNTY PHONE PHONE NUMBER OF SAMPLES EMAIL ADDRESS Do Not notify me when report is

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