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 BIC):

Phone: Fax: Email:

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)

*Crop Species: Variety:

Lot No:

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

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

Grower: Certification Class:

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

Other Info:
*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)	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

Prepare sample by sealing it securely so no seeds can escape. If moisture test is requested, put the sample into a Ziploc bag and squeeze most of the air out.

Minimum sample size for germination and TZ is 400 seeds; purity 2500 seeds, OSD 25,000 seeds. We request that you send at least 10% more seeds than are required for the tests you indicate. If needed, we can return most of the leftover seed after testing is complete.

Send this form with the sample 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@oscs.orst.edu

For Lab Use Only:

Date Sampled: ______________ Date Rec’d at Lab: ____________ By _____ & _____

Lab Test Number: __________________

Comments:

OSU Seed Lab

Request for ISTA Blue Certificate

WI-218b.3 Request for ISTA Blue Certificate	Approved 6/22/15 by J. Keeling	Pg 1 of 1

Name of Training

Kim Armstrong

2015-06-24

Jodi Keeling

Seed Certification