State/Territory Full Name:
2 Character State Code:
Department Name:
Division:
Address:
Address 2:
City:
Postal Code:
First Name:
Last Name:
Phone:
Mobile Phone:
Email Address:
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 Address:
Billing Address 2:
Billing City:
Billing State (2 Character Code):
Purchase Order:
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.
Name:
