Apply for Funding | National ROPS Rebate Program

First Name:

Last Name:

Farm Name:

Address:

City:

State:

Zip:

County:

Fax:

Primary Phone:

Secondary Phone:

Email:

Verify Email:

Preferred Method to Receive Letters: Email U.S. Post

Farm location if different than home address.

Farm Address:

Farm City:

Farm State:

Farm Zip:

Farm Phone:

Farm Fax:

Tractor Brand:

Tractor Model:

Tractor Year:

Please enter your tractor make and model here and continue the application.

Check this box if tractor make and/or model is not listed:

Second Choice Tractor Brand:

Second Choice Tractor Model:

Second Choice Tractor Year:

Preference for ROPS:

Canopies are not eligible for rebate in most states.

Are you a Farm Bureau Member?:

Are you a National Farmer Union Member?:

Farmer:

Full Time or Part Time:

Primary Farm Commodity:

Please explain your farm commodity:

Animal Type:

Number of Animals:

Number of Acres Farmed:

Number of Tractors:

Numbers of Tractors with ROPS:

Number of hours per week retrofitted tractor will be used:

Installation Preference:

Dealer - Why?

Self Installation - Why? Self Installation Helper

Considered retrofitting a tractor previous to program?

Previously retrofitted a tractor?

Have you ever been in a serious accident on a tractor?

If yes, please explain:

ROPS kits come with seatbelts. After intallation of ROPS on your tractor do you intend to wear your seatbelt?

Owner Seatbelt Use:

Family member seatbelt use:

Worker seatbelt use:

Reason for taking advantage of the program: (Check all that apply)

Safety - General
Rebate Money
Sun Protection
Safety for family/workers

Hilly Terrain
Had a scare - need to get it on
Requires for Operations
Other - Please explain

Why did you choose this tractor to retrofit? (Check all that apply)

Last one in fleet
My only tractor
Use this more
Family member uses this tractor

Worker/neighbor uses this tractor
Used on dangerous ground
Other - Please explain

How did you hear about the rebate program?

Source where heard:

Apply today to retrofit your tractor.

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