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.
Format: (000) 000-0000.
Fax
Please enter a valid phone number.
Format: (000) 000-0000.
PROPERTY DETAILS
# of breeding ewes
*
Breed(s)
*
Total # of sheep
*
Other enterprises
PURCHASE OF EXTINOSAD POUR-ON
Date purchased
*
-
Month
-
Day
Year
Date
Place of purchase
*
Volume purchased (L)
*
Batch number(s) and expiry
*
TREATMENT WITH EXTINOSAD POUR-ON
Treatment start date
*
-
Month
-
Day
Year
Date
Treatment finish date
*
-
Month
-
Day
Year
Date
Total volume used (L)
*
NUMBER OF UNSHORN, SUCKLING LAMBS TREATED ACCORDING TO VOLUME APPLIED*
(please complete at least one of the fields below)
5mL
7.5mL
15mL
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
15mL
20mL
25mL
30mL
35mL
40mL
Higher volume (mL)
Number treated
Terms & Conditions
*
I have read, and accept the below Guarantee Terms and Conditions
Privacy Policy
*
I have read Elanco’s
Privacy Policy
Marketing Consent
I consent to receive marketing communications (including electronic communications about products and services from Elanco)
Submit
Should be Empty: