Identification Request Form
Name:
Date:
Email:
Phone number
Type of sample submitted:
Where have the insects been discovered?
Number of insects observed?
How long have you noticed the insects?
Please attach photos if available:
Where was this plant found?
What type of plant is affected?
Describe Plant Symptoms:
What part of plant is affected? (check all that apply)
Where are the symptoms located? (check all that apply)
How long have you noticed the symptoms?
Where is the plant located? (check all that apply)
Have you used any chemical treatments (pesticides, fertilizers, etc.)?
If YES, what and when?
