EXTINOSAD POUR ON SIX MONTH GUARANTEE REGISTRATION

Name*

First NameLast Name
Trading Name*
ABN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*

Confirmation Emailexample@example.com
Phone*
Please enter a valid phone number.
Fax
Please enter a valid phone number.
PROPERTY DETAILS
# of breeding ewes*
Breed(s)*
Total # of sheep*
Other enterprises
PURCHASE OF EXTINOSAD POUR-ON
Date purchased*

MonthDayYear
Date
Place of purchase*
Volume purchased (L)*
Batch number(s) and expiry*
TREATMENT WITH EXTINOSAD POUR-ON
Treatment start date*

MonthDayYear
Date
Treatment finish date*

MonthDayYear
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
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PROPERTY DETAILS