"New Seed Dealer License Application Form" - Arizona

New Seed Dealer License Application Form is a legal document that was released by the Arizona Department of Agriculture - a government authority operating within Arizona.

Form Details:

  • Released on May 1, 2011;
  • The latest edition currently provided by the Arizona Department of Agriculture;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Arizona Department of Agriculture.

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Download "New Seed Dealer License Application Form" - Arizona

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Arizona Department of Agriculture (ADA)
Licensing and Registration Section
For ADA/ESD Use Only
1688 West Adams, Phoenix, Arizona 85007
License #
Phone:
(602) 542-3578
Check #
Fax:
(602) 542-0466
Check Date
Check Amount
Line #
New Seed Dealer License Application
ARS 3-235; AAC R3-4-408
For the year ending June 30, ________
Fee amount - $50.00
Company Name
Federal Tax ID#*
Email
Owner
Social Security #
Phone
Fax
Contact person
Do you have a Seed Labeler License?
Yes
No If yes, Seed Labeler License #
*Application will not be processed without an Federal tax ID number .
Mailing Address
Physical Address (location business is conducted)
Address
Address
City
City
State
Zip
State
Zip
A Seed Dealer, as defined in ARS 3-231(6), means any person who sells seed.
ARS 3-235(A) states that a seed dealer must obtain a license for each separate location from which seed is sold in this state. Please
contact the division if additional applications for licenses are needed.
Incomplete applications will be returned.
Each license issued shall be valid for a period of one year , or portion thereof, and shall expire annually on June 30. If you w ould like to
apply for a new license, please return this application form along with your payment of $50.00
The information contained in this application is true and accurate to the best of my knowledge. I understand that providing false
information is a felony in Arizona
Print Name ________________________________________________________________________
Signature
Date
rev 05\11
Print Form
Arizona Department of Agriculture (ADA)
Licensing and Registration Section
For ADA/ESD Use Only
1688 West Adams, Phoenix, Arizona 85007
License #
Phone:
(602) 542-3578
Check #
Fax:
(602) 542-0466
Check Date
Check Amount
Line #
New Seed Dealer License Application
ARS 3-235; AAC R3-4-408
For the year ending June 30, ________
Fee amount - $50.00
Company Name
Federal Tax ID#*
Email
Owner
Social Security #
Phone
Fax
Contact person
Do you have a Seed Labeler License?
Yes
No If yes, Seed Labeler License #
*Application will not be processed without an Federal tax ID number .
Mailing Address
Physical Address (location business is conducted)
Address
Address
City
City
State
Zip
State
Zip
A Seed Dealer, as defined in ARS 3-231(6), means any person who sells seed.
ARS 3-235(A) states that a seed dealer must obtain a license for each separate location from which seed is sold in this state. Please
contact the division if additional applications for licenses are needed.
Incomplete applications will be returned.
Each license issued shall be valid for a period of one year , or portion thereof, and shall expire annually on June 30. If you w ould like to
apply for a new license, please return this application form along with your payment of $50.00
The information contained in this application is true and accurate to the best of my knowledge. I understand that providing false
information is a felony in Arizona
Print Name ________________________________________________________________________
Signature
Date
rev 05\11