SSCA Tag Order	Date ______________

This order may be mailed, faxed or phoned to SSCA. If mailed or faxed, include tab report.

Mail to: SSCA	Phone to:	Fax to:	Date Shipped

P.O. Box 2619	334-821-7400	334-844-4901 VIA: _________

Auburn, AL 36831	For Office Use Only

Type of tag: Sew on ____ Adhesive label ____ Origin & year grown: State ____ Year ____

Applicant _________________________ Shipping Address ___________________________

___________________________________________ Zip ___________ Phone ____________

Billing Address ________________________________________________ Zip ____________

Person ordering ____________________________________ Date needed ________________

Name to go on tag if different than applicant _______________________________________

Company to bill if different than applicant _________________________________________

Address ______________________________________________________ Zip ____________

Class	Variety	Crop	Lot#	# Tags	Bag wt.	Test date

Analysis

Minimum/Maximum certification standards will be printed unless indicated differently below

Lot#	Pure	Inert	Crop	Weed	Germ	Hard	Noxious	For office use only
Tags
Freight
Royalty
Total