Retail Mouse Bait Order Form 2026

IMPORTANT: APVMA Emergency Permit #PER97414 18 May 2026 to 15 December 2026 allows the use of 50g Double Strength mouse bait if the user has successfully complete the Grain Producers Australia (GPA) training prior to purchase and use of the product, and if the area to be baited is within an AEZ classified by GRDC as having moderate or higher mouse pressure. https://grdc.com.au/resources-and-publications/resources/mouse-management

1. Please attach your Purchasing Certificate obtained through GPA Mouse Bait Stewardship course completion. *This question is required.

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Please note that all purchases of ZP50 mouse bait are reported to APVMA as obligated under Permit PER97414 18 MAY 2026 to 15 DECEMBER 2026

2. Customer Details *This question is required.

Trading Name

ABN

Address

City/Town

State

Post Code

First Name

Last Name

Mobile Number

Email Address for invoicing This question requires a valid email address.

3. Chemical Accreditation Number *This question is required. This question requires a valid number format.

4. Chemical Accreditation Expiry Date (dd/mm/yyyy) *This question is required. This question requires a valid date format of DD/MM/YYYY.

calendar

You must have a current Chem Cert Accreditation to be able to collect mouse bait containing S7

6. Order Request / Dispatch Details

125kg Drum Sterilised Grain ($1,075 + GST each ($8.60/kg + GST))

Space Cell	Number of 125kg Drums
Sterilised Grain	Sterilised Grain: Number of 125kg Drums

150kg Drum Unsterilised Grain ($1,072.50 + GST each ($7.15/kg + GST))

Space Cell	Number of 150kg Drums
Unsterilsed Grain	Unsterilsed Grain: Number of 150kg Drums

500kg BULK Bag Sterilised Grain @ $3,850 + GST each ($7.70/kg + GST)

Space Cell	Number of BULK Bags
Sterilised Grain	Sterilised Grain: Number of BULK Bags

500kg BULK Bag Unsterilised Grain ($3,000 + GST each ($6.00/kg + GST))

Space Cell	Number of BULK Bags
Unsterilised Grain	Unsterilised Grain: Number of BULK Bags

7. Comments

8. Preferred Collection Month *This question is required.

9. Confirmation of Order
This is confirmation of your order and acknowledging our terms and conditions. Please check your order carefully before placing your order. Prices and product availability are subject to change without notice. We will contact you to confirm availability and price, and to arrange payment and confirm your scheduled delivery date. *This question is required.

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Signature of

Retail Mouse Bait Order Form 2026 - 50g/kg Zn3P2

Manufacturers of "Last Supper " Zinc Phosphide Mouse Bait (Broadacre).