C1.FORMS DMR 11.24.

22

DAILY PRESCRIPTION SUMMARY (F.O.R.M.S)

TD / PD NAME: _________________________________ DISTRICT: _________ AREA: _____________________________ CLUSTER: ______________ MONTH: ___________________ WEEK: ______
DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 WEEK TOTAL
PRODUCTS QTY QTY QTY QTY QTY QTY PRESC. QTY
PRESC. QTY NO. OF PF NO. OF BF PRESC. QTY NO. OF PF NO. OF BF PRESC. QTY NO. OF PF NO. OF BF PRESC. QTY NO. OF PF NO. OF BF PRESC. QTY NO. OF PF NO. OF BF PRESC. QTY NO. OF PF NO. OF BF
SOLD SOLD SOLD SOLD SOLD SOLD QTY SOLD

Micah 8%
Niclomax 70 WP
Fungufree Plus 50 WP
S1
Slam! 2.5 EC
Top Rank 50 SP
Primaphos 50 EC
Vegaton 30 EC
Grastop 70 EC
Sakuhol 6%
Fungutek 500 SC
S2 Sachi Gold MB
Terrapest 40 SP
Baxprol 10 SC
Borex 5 SC
Manguard 300 OD
Vasthrin 5EC
Breaker 31.5 EC
Fungufree 80 WP
S3 Demolition X 480 SL
Fruitect
Turboost Gro
Deadshock 150 SL
Dupron 80 WP
RAT-X
Carbomax 3G
Triple 2,4-D Amine
S4 VAST 2,4-D Ester
VAST Malathion 57 EC
Yield Master 15-15-30
Yield Master 20-20-20
Starmax
NIMBUS DF
NIMBUS MANUAL
SP NIMBUS MIST BLOWER
Titon Pro
WeeSoo 12-43-0-1
TOTAL QTY
TOTAL # OF BRANDS

SUBMITTED BY (SIGNATURE AND PRINTED NAME): ___________________________________________________ CHECKED BY (SIGNATURE AND PRINTED NAME): ______________________________________________________