Commercial Turfgrass Sample Submission Form Phone: (608) 845-2535 Fax: (608) 845-8162 Email: firstname.lastname@example.org Turfgrass Diagnostic Lab O.J. Noer Facility 2502 Highway M Verona, WI 53593-9537 If you prefer to use our paper form, you can download it here then print it and mail it to us.TDL Contract Holder:*YesNoSubmitter's Name:* First Last Business Name:*Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime Phone:Email:* Sample InformationTurf Species:Location: Lawn/rough Sod Field Green Tee Fairway Athletic Field Height of Cut:Approx. Age of Stand:Problem DescriptionDescribe symptoms, plant parts affected, pattern of occurrence, etc.Chemical and Fertilizer ApplicationsList any recent pesticide applications (please include the date and rate of the pesticide application):PhotosPlease consider submitting digital photographs of the affected area to provide us a visual indication of the symptoms. Photos can be texted to (608) 445-5490 or email to email@example.com. Please indicate the name of the submitter when sending digital photographs.PaymentPayment Methods: - Pay at Time of Submission - you can include a check or money order when you submit your sample(s). - Payment Following Diagnosis and Receipt of Invoice: o By check or money order o Pay online Make checks and money orders payable to Turfgrass Diagnostic Lab. Submission Fees: $100 for diagnosis without written report $150 for diagnosis including a written report How to Prepare Your SamplesSamples should be: - Collected at the interface of the affected and unaffected turfgrass. - Approximately 6" in diameter (cup cutter size) and taken deep enough to include the plant's root mass. - Wrapped in aluminum foil and shipped immediately to avoid contamination and decay. If you enclose paperwork, please put it in a plastic bag so the moisture from the sample won't harm the paper. If you have questions about the sample submission process, please contact the lab. Please enter the alphanumeric characters in the box below.Thank you for your business.Questions?Please contact Kurt Hockemeyer at 608-845-2535 or firstname.lastname@example.org if you have any questions.PhoneThis field is for validation purposes and should be left unchanged.