Form FDACS-13356 "Request for Username & Password for Electronic Temik Permit Application" - Florida

What Is Form FDACS-13356?

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

Form Details:

  • Released on April 1, 2008;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • 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 FDACS-13356 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-13356 "Request for Username & Password for Electronic Temik Permit Application" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Agricultural Environmental Services
Please mail or fax to:
Pesticide Certification Section
REQUEST FOR USERNAME & PASSWORD
Attn: Temik Coordinator
FOR ELECTRONIC TEMIK PERMIT APPLICATION
3125 Conner Blvd., Bldg. 8 (L8)
Tallahassee, FL 32399-1650
Sections 487.042, 487.051, F.S. and Rule 5E-2.028, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7870; FAX (850) 617-7895
COMMISSIONER
I request a Username and Password to use the electronic aldicarb (Temik) permit application process. I also
authorize the Department of Agriculture and Consumer Services to update my pesticide applicator license file
with the following information:
Applicator Name:
Last
First
Middle
Suffix
Pesticide Applicator License Number:
License Expiration Date:
Mailing Address:
Business Address:
Cell Phone Number:
AgNet Number:
E-mail Address:
Home Phone Number:
Business Phone Number: Business Fax Number:
Applicator Signature:
Date:
******MUST BE SIGNED AND DATED******
FOR DACS USE ONLY Username:
Password:
Date Sent:
Method
Mail
Fax
E-mail By:
FDACS-13356 Rev. 04/08
Florida Department of Agriculture and Consumer Services
Division of Agricultural Environmental Services
Please mail or fax to:
Pesticide Certification Section
REQUEST FOR USERNAME & PASSWORD
Attn: Temik Coordinator
FOR ELECTRONIC TEMIK PERMIT APPLICATION
3125 Conner Blvd., Bldg. 8 (L8)
Tallahassee, FL 32399-1650
Sections 487.042, 487.051, F.S. and Rule 5E-2.028, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7870; FAX (850) 617-7895
COMMISSIONER
I request a Username and Password to use the electronic aldicarb (Temik) permit application process. I also
authorize the Department of Agriculture and Consumer Services to update my pesticide applicator license file
with the following information:
Applicator Name:
Last
First
Middle
Suffix
Pesticide Applicator License Number:
License Expiration Date:
Mailing Address:
Business Address:
Cell Phone Number:
AgNet Number:
E-mail Address:
Home Phone Number:
Business Phone Number: Business Fax Number:
Applicator Signature:
Date:
******MUST BE SIGNED AND DATED******
FOR DACS USE ONLY Username:
Password:
Date Sent:
Method
Mail
Fax
E-mail By:
FDACS-13356 Rev. 04/08