Form DP-23 "Restricted Use Pesticide Dealer's License" - Arkansas

What Is Form DP-23?

This is a legal form that was released by the Arkansas Agriculture Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2020;
  • The latest edition provided by the Arkansas Agriculture Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DP-23 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-23 "Restricted Use Pesticide Dealer's License" - Arkansas

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Form DP-23 (Rev.10-20)
APPLICATION FOR A RESTRICTED USE PESTICIDE DEALER’S LICENSE
UNDER THE PESTICIDE USE AND APPLICATION ACT AND ARKANSAS REGULATIONS ON
PESTICIDE CLASSIFICATION
INSTRUCTIONS: Complete the sections below and submit, along with the $65.00 license fee, to the Arkansas
Department of Agriculture, Plant Industries Division, Pesticide Section, 1 Natural Resources Dr, Little
Rock, Arkansas 72205. Use a separate application for each location.
MAKE CHECK PAYABLE TO: ARKANSAS STATE PLANT BOARD
Out-of-state: persons or firms- Out of state dealers may obtain a single license for their principal location which
distributes pesticides into the State of Arkansas. Attach Power of Attorney (forms enclosed) designating an
Arkansas resident for service of process.
DEALER’S LICENSE: For dealers selling, offering for sale or distributing restricted use pesticides (including
products designated Class E or F, or H in containers of more than ONE [1] quart). A SEPARATE LICENSE IS
REQUIRED FOR EACH LOCATION.
I hereby certify that I will observe the Regulations on Restricted Use Pesticides and Pesticide Classification. In
particular I agree to sell or distribute Restricted Use Pesticides only to licensed custom, commercial, non-
commercial, and private applicators or to other licensed Dealers. I will maintain a record of each sale or
distribution for two (2) years, and permit inspection by the Department staff upon request.
Dealer Name: ____________________________________________________________
Mailing Address: _____________________________________________________________
____________________________________________________________________________
City
State
Zip Code
Physical Address: ____________________________________________________________
____________________________________________________________________________
City
State
Zip Code
Contact Person:_________________________ Email Address:________________________
Telephone Number:_____________________ Fax Number:___________________________
Signature:____________________________ Amount Enclosed $______________________
**If you have any questions, please call 501-225-1598 or email
pesticide.dealer@arkansas.gov
**
DO NOT WRITE IN THIS SPACE
License approved for the Calendar year 20______
License Number:__________________________
Issue Date:_______________________________
Form DP-23 (Rev.10-20)
APPLICATION FOR A RESTRICTED USE PESTICIDE DEALER’S LICENSE
UNDER THE PESTICIDE USE AND APPLICATION ACT AND ARKANSAS REGULATIONS ON
PESTICIDE CLASSIFICATION
INSTRUCTIONS: Complete the sections below and submit, along with the $65.00 license fee, to the Arkansas
Department of Agriculture, Plant Industries Division, Pesticide Section, 1 Natural Resources Dr, Little
Rock, Arkansas 72205. Use a separate application for each location.
MAKE CHECK PAYABLE TO: ARKANSAS STATE PLANT BOARD
Out-of-state: persons or firms- Out of state dealers may obtain a single license for their principal location which
distributes pesticides into the State of Arkansas. Attach Power of Attorney (forms enclosed) designating an
Arkansas resident for service of process.
DEALER’S LICENSE: For dealers selling, offering for sale or distributing restricted use pesticides (including
products designated Class E or F, or H in containers of more than ONE [1] quart). A SEPARATE LICENSE IS
REQUIRED FOR EACH LOCATION.
I hereby certify that I will observe the Regulations on Restricted Use Pesticides and Pesticide Classification. In
particular I agree to sell or distribute Restricted Use Pesticides only to licensed custom, commercial, non-
commercial, and private applicators or to other licensed Dealers. I will maintain a record of each sale or
distribution for two (2) years, and permit inspection by the Department staff upon request.
Dealer Name: ____________________________________________________________
Mailing Address: _____________________________________________________________
____________________________________________________________________________
City
State
Zip Code
Physical Address: ____________________________________________________________
____________________________________________________________________________
City
State
Zip Code
Contact Person:_________________________ Email Address:________________________
Telephone Number:_____________________ Fax Number:___________________________
Signature:____________________________ Amount Enclosed $______________________
**If you have any questions, please call 501-225-1598 or email
pesticide.dealer@arkansas.gov
**
DO NOT WRITE IN THIS SPACE
License approved for the Calendar year 20______
License Number:__________________________
Issue Date:_______________________________