Enter your information (yellow) and add items (green) to the invoice below (blue)
When done, click "Print Invoice" for your records and then click "Submit Invoice"

For first time customers ordering product in season (April 15 - August 30), we require payment up front for the first season. All others, payment is due upon reciept of the product.

Name:

Address:

City:

State:

Zip:

Phone:

License #:

Expires:

Agricultural Chemical Solutions, Inc.

6525 East 82nd Street Suite 210M

Indianapolis, IN 46250

For Sales Information Call (317) 891-1146

Invoice to:

INVOICE

Date: 12/13/2018

Invoice #29700-121318

Restricted Use Applicator #

Expiration Date:

Add $250 shipping charge to total below
for orders with no shuttles or under $5,000

Item Description Packaging Qty Rate Amount