AG Water Order Form

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Please provide us with the following information.

PUMP OPERATOR

Operator First Name: *
Operator Last Name: *
Operator Phone: *
Operator Email: *

PUMP OWNER (if same as operator leave blank)

Owner First Name:
Owner Last Name:
Owner Phone:
Owner Email:

IRRIGATION SCHEDULE (In accordance with Rule No. 120 orders must be placed 48-hours in advance of irrigating.)

Pump ID#: *
Diversion Rate: (in gpm) *
Start Date: *
Start Time *HHMMAM/PM
End Date: *
End Time: *HHMMAM/PM
Run Time (hrs per day)
Comments/Notes:

Verification

Please enter any two digits *Example: 12
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