Test April Deployment

User Information

First Name*

Last Name*

Business/Farm name*

Job Title

Phone

Mobile Phone*

Preferred Communication*

Phone

Text Me*

Yes

Email Me*

Yes

Contact*

Yes

Email Address*

Website

Mailing Address*

Address Line 1

Address Line 2

City

State

Zip Code

Physical Address*

Same as Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

End User Operation

Crops

Acres

Products Applied

Traits

Farming Practices

Irrigation

File Attachment

Terms and Conditions

Text related to the terms and conditions come here

I agree to the terms & conditions

Notice Under California Consumer Privacy Act (“CCPA”)

Please be aware that by registering with BASF to learn more about products and services, downloading a mobile application, signing up for a platform or online service, making purchases, or initiating other business transactions or requests with BASF, BASF will be collecting certain personal information about you and your internet activity for specific business purposes. For a description of the information collected about you and the business purposes for which that information is used, please review BASF’s Privacy Policy, which may be accessed here: https://www.basf.com/us/en/legal/data-protection.html