"Request to Take the Virginia Pesticide Business License Examination" - Virginia

Request to Take the Virginia Pesticide Business License Examination is a legal document that was released by the Virginia Department of Agriculture and Consumer Services - a government authority operating within Virginia.

Form Details:

  • Released on May 1, 2019;
  • The latest edition currently provided by the Virginia Department of Agriculture and Consumer Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Virginia Department of Agriculture and Consumer Services.

ADVERTISEMENT
ADVERTISEMENT

Download "Request to Take the Virginia Pesticide Business License Examination" - Virginia

2983 times
Rate (4.6 / 5) 178 votes
VIRGINIA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES
OFFICE OF PESTICIDE SERVICES
P. O. Box 526 • Richmond, VA 23218
Phone: (804) 225-2223 • Fax: (804) 786-9149 • www.vdacs.virginia.gov
REQUEST TO TAKE THE VIRGINIA PESTICIDE BUSINESS LICENSE EXAMINATION
For businesses that only sell pesticides and are not required to have a certified commercial applicator.
Before this request to take the Virginia Pesticide Business License examination can be processed, the (1)
application for Pesticide Business License must be completed and submitted to the Virginia Department of
Agriculture and Consumer Services at the address above along with the (2) $150.00 annual business license
fee and (3) evidence of financial responsibility. If you have any questions, please call Alanna Ostrowski at
804-225-2223 or send an email to alanna.ostrowski@vdacs.virginia.gov.
PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION:
Person taking the Virginia Pesticide Business License Exam:
SOCIAL SECURITY NO. or ITIN (REQUIRED): __________ - ______ - __________
HOME PHONE NO.:_______________________________
EMAIL: _________________________________________
NAME OF APPLICANT: ___________________________________________________________________________________
(Last)
(First)
(M.I.)
MAILING ADDRESS: ______________________________________________
COUNTY: ___________________________
(Street or RFD)
CITY: ________________________________________________
STATE: __________
ZIP CODE: __________________
Business Name:
LEGAL NAME OF BUSINESS: _____________________________________________________________________________
TRADING AS: ___________________________________________________________________________________________
BUSINESS PHONE NO: ___________________________________________________________________________________
(Area Code)
Business Mailing Address:
MAILING ADDRESS: ____________________________________________________ CITY: ________________________
COUNTY: ___________________________________ STATE: _____________ ZIP CODE: __________________________
Business Physical Location Address:
STREET: _____________________________________________ CITY: ____________________________________________
COUNTY: __________________________________________ STATE: ________________ ZIP CODE: __________________
________________________________________________________
SIGNATURE:
DATE: ____________
FOR DEPARTMENT USE ONLY:
Business License No:
Date Keyed:
9/20
Keyed by:
VIRGINIA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES
OFFICE OF PESTICIDE SERVICES
P. O. Box 526 • Richmond, VA 23218
Phone: (804) 225-2223 • Fax: (804) 786-9149 • www.vdacs.virginia.gov
REQUEST TO TAKE THE VIRGINIA PESTICIDE BUSINESS LICENSE EXAMINATION
For businesses that only sell pesticides and are not required to have a certified commercial applicator.
Before this request to take the Virginia Pesticide Business License examination can be processed, the (1)
application for Pesticide Business License must be completed and submitted to the Virginia Department of
Agriculture and Consumer Services at the address above along with the (2) $150.00 annual business license
fee and (3) evidence of financial responsibility. If you have any questions, please call Alanna Ostrowski at
804-225-2223 or send an email to alanna.ostrowski@vdacs.virginia.gov.
PLEASE TYPE OR PRINT THE FOLLOWING INFORMATION:
Person taking the Virginia Pesticide Business License Exam:
SOCIAL SECURITY NO. or ITIN (REQUIRED): __________ - ______ - __________
HOME PHONE NO.:_______________________________
EMAIL: _________________________________________
NAME OF APPLICANT: ___________________________________________________________________________________
(Last)
(First)
(M.I.)
MAILING ADDRESS: ______________________________________________
COUNTY: ___________________________
(Street or RFD)
CITY: ________________________________________________
STATE: __________
ZIP CODE: __________________
Business Name:
LEGAL NAME OF BUSINESS: _____________________________________________________________________________
TRADING AS: ___________________________________________________________________________________________
BUSINESS PHONE NO: ___________________________________________________________________________________
(Area Code)
Business Mailing Address:
MAILING ADDRESS: ____________________________________________________ CITY: ________________________
COUNTY: ___________________________________ STATE: _____________ ZIP CODE: __________________________
Business Physical Location Address:
STREET: _____________________________________________ CITY: ____________________________________________
COUNTY: __________________________________________ STATE: ________________ ZIP CODE: __________________
________________________________________________________
SIGNATURE:
DATE: ____________
FOR DEPARTMENT USE ONLY:
Business License No:
Date Keyed:
9/20
Keyed by: