Fill out one application for each lot to be sampled. *Information is REQUIRED

Applicant Information (will appear on the certificate exactly as it is written here)

*Name:

*Address:

Contact Information (not to appear on OIC):

Phone: Fax: Email:

Check here if applicant should NOT appear on Orange certificate.

Check if customer/billing is different than applicant. Billing name and address:
Seed Identification (will appear on the certificate exactly as it is written here)

*Variety and Crop Species (write in order you want it to appear on certificate):

*Lot No:

*No. of containers:	Type:	*Lot Weight:	* lbs / kg

*Crop Year (for germination, not incl. on OIC):

Grower: Certification Class:

*Treated or Coated Seed? NO YES with *PLEASE PROVIDE MSDS SHEET

Other Info:
Sampling Information

*Location of sampling (PLEASE INCLUDE ADDRESS):

*Seed is prepared as described below, SET DOWN and ready for sampling: YES NO

It is your responsibility to contact your warehouse and tell them sampling has been requested.

Special instructions to sampler:
*ISTA Tests Needed

Purity (P)	Germination (G)	Fluorescence (FL)	Tetrazolium (TZ)

Other Seed Determination (OSD) scope: Complete Reduced ( g)	Limited:

Moisture (M) Weight Det (1000wt)	Australia	Other (specify):
ISTA Certificate

Provisional (prelim) needed. Indicate the tests you want included on the provisional:

Duplicate certificates: Quantity

Charges will apply for provisional and duplicate certificates (Original is included in testing price)

Special instructions for reporting on certificate:
Instructions

Seed lot preparation prior to sampling: Seed lot must be a finished product as it is going to be in the final container. The lot must be properly identified and the amount quantified with total weight in lbs. or Kg. and number of bags. The lot can be piled up to 2 pallets high and all four sides of the pile must be accessible for sampling. If the lot is not SET DOWN AND READY for sampling, the sampler cannot sample and you may be charged a show-up fee.

Send this form to the OSU Seed Lab.

OSU Seed Lab	Phone: 1-541-737-4464

3291 SW Campus Way	Fax: 1-541-737-2126

Corvallis, OR 97331	Email: seedlab@oregonstate.edu
For Lab Use Only:

Date Sampled: ______________	Date Rec’d at Lab: ____________ Lab Test #: _____________

Name of Sampler: _____________________ Seal & Bag intact: YES NO Sampling Fee:______

Sampling OK? Checked by _______ & _______ Sample Entry checked by _______ & _______

Comments:

OSU Seed Lab

Request for ISTA Orange Certificate

WI-218a.7 Request for ISTA Orange Certificate	Approved 11/4/15 by J. Keeling	Pg 1 of 1

Name of Training

Kim Armstrong

2015-11-04

Jodi Keeling

Seed Certification