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ProfitMAX Consultation Request Form
First Name:
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Last Name:
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Address:
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City:
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State:
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Phone:
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County
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ZipCode
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Fax:
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Email:
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Business Information
Company/Farm Name:
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Breeds on Farm
Dairy:
Holstein
Jersey
Red and White
Ayrshire
Brown Swiss
Guernsey
Milking Shorthorn
Other
Beef:
Angus
Simmental
Red Angus
Hereford
Charolais
Shorthorn
Brahman
Other
Are you a Select Sires customer?
Yes
No
Herd Size
1-10
11-50
51-100
100 - 500
500 - 1,000
2,000 - 5,000
5,000 - 10,000
> 10,000
Operation Goal:
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(What would you like to accomplish? i.e. increase milk production, more heifers, etc.)
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