Purchase Data Authorization Form

In order to participate in grower programs, Dow AgroSciences must have access to your purchase information. Please complete the authorization form below.

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Please use the format A1A1A1.
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Please enter numbers only (e.g. 5555555555 or 18005555555)
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Yes, I would like to receive agronomy advice (AgWise e-newsletter), special offers and product information through electronic communications from Dow AgroSciences.
Does your farm make group purchases and farm collectively?
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If you farm in conjunction with other individuals, make group purchases and farm your land collectively, list the other individual’s information.
Group Purchase: Information for Contact/Company 2
Please use the format A1A1A1.
Please enter numbers only (e.g. 5555555555 or 18005555555)
Group Purchase: Information for Contact/Company 3
Please use the format A1A1A1.
Please enter numbers only (e.g. 5555555555 or 18005555555)