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"

Name:

Address:

City:

State:

Zip:

Phone:

Email:

License #:

Expires:

Agricultural Chemical Solutions

2525 North Shadeland Ave. Box B-14

Indianapolis, IN 46219

For Sales Information Call (317) 891-1146

Invoice to:

INVOICE

Date: 12/23/2024

Invoice #30195-122324

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