Name
*
First Name
Last Name
Trading Name
*
ABN
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Confirmation Email
example@example.com
Phone
*
Please enter a valid phone number.
PROPERTY DETAILS
Fax
Please enter a valid phone number.
# of breeding ewes
*
Total # of sheep
*
Breed(s)
*
Other enterprises
PURCHASE OF VIPER POUR-ON
Date purchased
*
-
Month
-
Day
Year
Date
Place of purchase
*
Volume purchased (L)
*
Batch number(s) and expiry
*
TREATMENT WITH VIPER POUR-ON
Treatment start date
*
-
Month
-
Day
Year
Date
Treatment finish date
*
-
Month
-
Day
Year
Date
Total volume used (L)
*
NUMBER OF UNSHORN LAMBS TREATED ACCORDING TO VOLUME FROM 2 WEEKS TO 2 MONTHS OF AGE
(please complete at least one of the fields below)
12mL
15mL
20mL
Higher volume (mL)
Number treated
NUMBER OF SHEEP TREATED UP TO 7 DAYS OFF SHEARS ACCORDING TO VOLUME APPLIED
(please complete at least one of the fields below)
Lower volume (mL)
Number treated
12mL
15mL
20mL
25mL
30mL
40mL
60mL
80mL
90mL
Higher volume (mL)
Number treated
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