Purdue Plant Diagnostic Lab — Pest Submission Form

Fill out by hand and mail with your sample, or fill in on-screen and print.

Submitter Information

First name

Last name

Business / organization

Address

City

State

Zip

County

Phone

Type (tick all that apply)

Damaging Plant Biting or Stinging Infested Food Nuisance Other

If other, please specify

Number Observed (tick one)

Many Few Unknown

Date first noticed

Chemicals / fertilizers applied (last 2 years)

Describe the problem

Plant or Host

Cultivar Variety

% of plants affected (tick one)

<25% 25-50% 50-75% >75%

Approximate Plant Age

Location (tick all that apply)

Putting Green Surround Fairway Tees Athletic Field Park/Cemetery Sod Farm Commercial Other

If other, please specify

Sun Exposure (tick all that apply)

Full Sun Partial Sun Full Shade Unknown

Mail this form along with your physical sample to the Purdue Plant Diagnostic Lab.

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