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Dupont Harmony Discount Form
Harmony
®
Instant Discount Booking Form
To Qualify for a discount, this online form must be submitted by the grower by no later than March 1
st
, 2010.
Farm Name:
First Name:
*
Last Name:
*
Address:
*
City:
*
Province:
-- select --
Alberta
British Columbia
Manitoba
Saskatchewan
*
Postal Code:
*
Telephone:
*
Fax:
Email:
*
Herbicide Retailer
Retailer Name:
*
City:
*
Harmony® Instant Discount Program:
Book 640+ acres (16 cases or 4 totes) and save $75/case.
Book 1920+ acres (48 cases or 12 totes) and save $95/case.
Products
Products Booked
Acres Booked
Harmony® SG
cases
x 40 acres
Harmony® SG MEGA
totes
x 160 acres
Harmony® K
cases
x 40 acres
Harmony® K MEGA
totes
x 160 acres
Harmony® GRASS PrecisionPac™
(plus PrecisionPac™ in-crop broadleaf product)
totes
x 160 acres
Total Harmony®
Book matching acres of Assure® II or Express® brands and save an additional $10 off per case on your Harmony®.
Assure® II
jugs
x 40 acres
Express® PRO
jugs
x 80 acres
Express® SG
jugs
x 80 acres
Total matching
DuPont treats the information that you provide as confidential. We use this information to send you product information or offers that are relevant to your farm.
I would like to receive e-mails from DuPont with offers or product information relevant to my farm.
Click here
to learn about our privacy policy, or you can call us at 1-800-667-3925.
I authorize my preferred herbicide dealer (listed above) to release my transactional information to DuPont as required.
For full offer details, please refer to the program
Terms & Conditions
. Visit www.dupont.ca/ag or call 1-800-667-3925.
If you would like to download and submit a paper version of this form, please
click here
.