Field ID Number ______________________________________
Address ______________________________________________
City _________________________________________________
State ________________________________________________
Zip __________________________________________________
Phone ________________________________________________
Fax __________________________________________________
E-mail _______________________________________________
Date _________________________________________________
Last Crop Grown ______________________________________
Crop to be Grown _____________________________________
FMX I
$26.00
FMX II
$26.00
FMX I & II
$30.00
Nitrate
$4.00
Expedite
$1.50
A & L Plains Laboratories
302 34th Street, PO Box 1590
Lubbock, Texas 79408