DEA Form 488 Worksheet a - Application for Import Quota for Ephedrine, Pseudoephedrine, and Phenylpropanolamine Part 12(Ii)(A) - Domestic Disposition (Sale) / Utilization

Form EIB-SBA488 or the "Worksheet A - Application For Import Quota For Ephedrine, Pseudoephedrine, And Phenylpropanolamine Part 12(ii)(a) '- Domestic Disposition (sale) / Utilization" is a form issued by the U.S. DEPARTMENT OF JUSTICE - DRUG ENFORCEMENT ADMINISTRATION.

The form was last revised in March 31, 2019 and is available for digital filing. Download an up-to-date fillable Form EIB-SBA488 in PDF-format down below or look it up on the U.S. DEPARTMENT OF JUSTICE - DRUG ENFORCEMENT ADMINISTRATION Forms website.

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WORKSHEET A
U.S. Department of Justice
Drug Enforcement Administration
APPLICATION FOR IMPORT QUOTA FOR EPHEDRINE, PSEUDOEPHEDRINE, AND PHENYLPROPANOLAMINE
PART 12(II)(a) – DOMESTIC DISPOSITION (SALE) / UTILIZATION
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
Email:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
If you need additional pages, please copy this one and complete.
DEA FORM 488 (Worksheet A)
(3/31/2019)
RESET FORM
PRINT FORM
WORKSHEET A
U.S. Department of Justice
Drug Enforcement Administration
APPLICATION FOR IMPORT QUOTA FOR EPHEDRINE, PSEUDOEPHEDRINE, AND PHENYLPROPANOLAMINE
PART 12(II)(a) – DOMESTIC DISPOSITION (SALE) / UTILIZATION
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
E-Mail:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
Name of Company or Manufacturer
Address
Contact Person
Telephone
FAX
DEA Registration No. (if applicable)
Email:
Quantity to be sold (grams) as
Intended Use
anhydrous base
(Choose the appropriate letter and place on corresponding line.)
Please provide documentation (purchase
(A) Sale / product launch
(B) Product development / research
(C) Other (explain)
orders, supply agreements, etc.).
If you need additional pages, please copy this one and complete.
DEA FORM 488 (Worksheet A)
(3/31/2019)
RESET FORM
PRINT FORM

Download DEA Form 488 Worksheet a - Application for Import Quota for Ephedrine, Pseudoephedrine, and Phenylpropanolamine Part 12(Ii)(A) - Domestic Disposition (Sale) / Utilization

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