UNSOLICITED SEED INFORMATION

LOUISIANA DEPARTMENT OF AGRICULTURE & FORESTRY
MIKE STRAIN DVM, COMMISSIONER
Seed Programs Division 5825 Florida Blvd., Suite 3004, Baton Rouge, LA 70806 Phone (225) 925-4733; Fax (225) 925-4124
UNSOLICITED SEED INFORMATION AND COLLECTION FORM
Section I. Seed Recipient Information
1) Date Reported:*

MonthDayYear
Date
2) Recipient Name:*

First NameLast Name
3) Phone Number:*

Area CodePhone Number
4) Email Address:*
example@example.com
5) Physical Address:*

Street Address

CityState / Province

Postal / Zip Code
6) When did the package arrive:*
7) Did you receive additional packages?*

YesNo
If yes, explain:
8) Were any of the seeds planted?*

YesNo
If yes, where were they planted?
9) Did you order anything from an e-commerce site? (EX: Amazon, Wish, Etc.)*

YesNo
If yes, from what company?
10) Did you order any seeds this year?

YesNo
If yes, what kind & from what company?
Should be Empty:

UNSOLICITED SEED INFORMATION AND COLLECTION FORM