Request State Account

State Account Information

State/Territory Full Name:

2 Character State Code:

Department Name:

Division:

Address:

Address 2:

City:

State:

Postal Code:

ALSTAR Account Administrator

First Name:

Last Name:

Phone:

Mobile Phone:

Email Address:

NSPIRS for ALSTAR State Participants

State Pesticide Product

Included at no charge for State ALSTAR participants

NSPIRS Upgrades:

Federal Pesticide Product ($500/yr)

Both Federal and PDMS ($1000/yr)

Billing contact and accounts payable contact required for those states wishing to purchase NSPIRS additional search features.

Billing Contact (authorizes payment)

First Name:

Last Name:

Phone:

Mobile Phone:

Email Address:

Billing Address

Billing Address:

Billing Address 2:

Billing City:

Billing State:

Postal Code:

Purchase Order:

Accounts Payable Contact (receives invoice and remits payment)

First Name:

Last Name:

Phone:

Mobile Phone:

Email Address:

By submitting this application, I acknowledge that I have reviewed the current ALSTAR subscription rates and authorize payment of charges incurred. I have also reviewed the ALSTAR Participation Standards and agree to abide by the standards. I understand that ALSTAR information is the intellectual property of CERIS and Purdue University. I agree that I will not reformat, reuse, or redistribute any ALSTAR information for commercial use, paid or otherwise without prior, written permission from the National Pesticide Information Retrieval System at CERIS.

Requestor

Name:

Email Address: