Dicamba Settlement Intake

First Name *

Last Name *

Email *

example@example.com

Phone Number *

Please enter a valid phone number.

State of Residence *

Do you grow soybeans? *

Yes No

Do you believe that your soybean crops were damaged by off-target movement of dicamba from a neighboring or nearby farm (i.e., a farm not owned or operated by you)? *

Yes No

Approximately how many acres of your soybeans do you believe were damaged by off-target movement of dicamba? *

What do you estimate your monetary losses as a result of off-target movement of dicamba to your soybean crops to be? *

What type of documents do you have that support your claim of dicamba damage to soybean crops? (check all that apply) *

Reports of an administrative agency (e.g., state department of agriculture or USDA) Reports of insurance adjusters or inspectors Reports of any weed scientists or university professors Reports from inspection by Monsanto or BASF Reports from crop scouts or other consultants Reports from an applicator who sprayed dicamba on a nearby farm None of the above Other (Please Describe)

Do you have any photos or videos showing your damages crops? *

Yes No

Did anyone other than you witness/observe the damage to your soybean crops? *

Yes No

Did you ever file a complaint regarding your crop damage with any administrative agency (e.g., a state department of agriculture or the USDA)? *

Yes No

Is there anything else you would like us to know about your potential claim?

Detected Location