FOR LAB USE Received: ___________ Replied: ___________ Check#: ___________ Sample#: ___________ Insect Diagnostic Laboratory (IDL) SUBMISSION FORM Name (Company, if sent from a business) Address Town, State, Zip Email (or a friend or relative’s email who can contact you directly with the results) Phone (include area code) If different -- Where sample came from: (Name) Address Town State, Zip Date sample was found Where found (kind of plant, food, "indoors", etc.) If found indoors: (house, office, etc.) room(s), floor(s): If outdoors not associated with a plant: (foundation, deck, etc.) Nature and extent of problem, and when it was first noticed If found on a plant: what kind of plant? Print Form (or Save Form by printing to PDF)or click here to print a blank form
