Micotil Form US Farm

After completing the training, complete the Certification Acknowledgement form below. If you prefer, you can download the PDF form and submit it via email to: micotil_certification@elancoah.com or call 800-364-2014 for assistance.

I am a Veterinarian or Distributor who has a license to receive and sell animal prescription productsI am a ProducerI am a teammate who needs to be informed of Micotil Safety information

Name*

First NameLast Name

Business Name*

Primary Business Address*

City*

State*

Zip Code*

Optional Secondary Address

Business Email*

example@example.com

I acknowledge that I completed Micotil Safe Handling and Use certification training on Date* (Date completed).

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