Your Name (required):
Your Email Address (required):

1. When it comes to your roses, would you describe yourself as a ( ) rose grower.

professional casual

fanatic hobbyist

other

2. How many roses do you have?

3. Check the box (N) none, (L) light, (M) moderate, or (H) heavy that best describes the primary insects and diseases you are trying to prevent or control? If you cannot identify the main pest problems please refer to our Galleries.

Insects	Diseases
N L M H Aphids N L M H Flower Thrips N L M H Japanese Beetle N L M H Rose Slug N L M H Spider Mites	N L M H Black Spot N L M H Downey Mildew N L M H Flower Blight N L M H Powdery Mildew N L M H Rust
List any others: Additional comments:
4. Check the box (E) excellent, (G) good, (F) fair, (P) poor, or (D) don't know that best describes the cultural and environmental conditions in your rose garden.
E G F P D soil type E G F P D water quality E G F P D sun exposure	E G F P D air circulation E G F P D drainage E G F P D fertility
Other pertinent cultural or environmental factors:

5a. List the Pesticides you are currently using:

5b. Fungicides list brands:



5c. Insecticides list brands:

5d. Are you satisfied with the materials you are currently using?
Yes No Somewhat

5e. Do you currently have pesticides less than two years old you'll need to use up? yes no
If so, what kind and how much do you have left?

*Note: materials older than 2 years may have exceeded their viable shelf life and may need to be disposed of through local hazardous material collections.

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6a. Have you ever used spray adjuvants (spray additives that enhance efficacy)?
yes no

6b. Check which type of spray equipment you own?
1 to 3 gal. hand sprayer Backpack sprayer Hose-end sprayer
Motorized tank sprayer other

6c. May we recommend the appropriate use of spray equipment for your size garden? yes no

6d. How many gallons of mixed spray solution do you normally use?

6e. How often do you spray your roses?
every 7 to 10 days semi-monthly monthly quarterly
as needed other explain

7. Are there any sensitive areas located near your rose garden that cannot be avoided when spraying?
neighbors fish pond pet area veg. garden
fruit trees others explain

8. Do you have any preference as to the type of material we recommend?
organic systemic contact lowest cost
longest lasting no preference best possible method
other explain

9. Can we include the appropriate pesticide measuring device?
yes no

10. Will you need any personal protective equipment?
yes no

11. Will you need any personal protective equipment:
gloves goggles disposable spray coveralls
respirator vinyl apron others

12. Other comments: