OKLAHOMA BOLL WEEVIL ERADICATION ORGANIZATION (OBWEO)
GROWER INFORMATION FORM

FSA FARM #

DEAR GROWER,
IN ORDER TO FACILITATE THE COMMUNICATION PROCESS BETWEEN PROGRAM PERSONNEL AND YOURSELF, PLEASE HELP US BY PROVIDING THE FOLLOWING INFORMATION.

PRODUCER NAME:

ADDRESS:
PO BOX/ STREET/ ROUTE; CITY/ STATE/ ZIP

HOME PHONE: _________________ MOBILE PHONE: _____________________

E-MAIL ADDRESS:

PLEASE LIST LEGAL DESCRIPTION AND ACREAGE OF ALL FIELDS WITH THE ABOVE FARM #.

EX: NW ¼ 9-8-13

Acres:

Prod Corp.#_______ (OBWEO USE ONLY)

OBWEO

P.O. Box 100

Hobart, OK 73651

Ph. (800) 246-4810 Fax (580) 726-8401