"Application for a Permit to Sell or Transfer Restricted Use Pesticides Under the Delaware Pesticide Law" - Delaware

This "Application for a Permit to Sell or Transfer Restricted Use Pesticides Under the Delaware Pesticide Law" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents with its latest version released on August 5, 2001.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Delaware Department of Agriculture.

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Download "Application for a Permit to Sell or Transfer Restricted Use Pesticides Under the Delaware Pesticide Law" - Delaware

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State of Delaware
Telephone
(302) 698-4500
Department of Agriculture
(800) 282-8685
DE Only
Pesticide Compliance
Fax
(302) 697-4483
2320 S. DuPont Hwy., Dover, DE 19901
Application for a Permit to Sell or Transfer Restricted Use Pesticides under
the Delaware Pesticide Law
I hereby apply for a permit to sell or transfer Restricted Use Pesticides in accordance with
regulations adopted under Section 21 of the Rules and Regulations of the Delaware Pesticide
Law.
PLEASE TYPE OR PRINT
Dealer Permit No.
Name of Contact Person
Contact Person/Phone Number
Dealership Name
Fax#
Address
City
State
Zip Code
I certify that I understand my legal responsibilities for the sale of Restricted Use
Pesticides and that I will sell Restricted Use Pesticides only to individuals who possess
a valid Pesticide Applicators Certificate.
Signature
Date
The annual fee for a Restricted Use Pesticide Dealer Permit is $25.00 and is payable to the Delaware
Department of Agriculture.
CHECK/MONEY ORDER
NEW!!!
CREDIT CARD
Fee - $25.00
Fee - $25.00
Visa
MasterCard
Discover
Billing Name:
Make Check or Money Order
Credit Card Billing
Address:
Payable to:
City/State/Zip:
*CVC# _____
Credit Card Number:
# is on the back of the card; 3 or 4
digits
Delaware Department of
/
Expiration Date:
Agriculture
Month
Year
Authorization:
Document No. 65-01-06/01/08/05
State of Delaware
Telephone
(302) 698-4500
Department of Agriculture
(800) 282-8685
DE Only
Pesticide Compliance
Fax
(302) 697-4483
2320 S. DuPont Hwy., Dover, DE 19901
Application for a Permit to Sell or Transfer Restricted Use Pesticides under
the Delaware Pesticide Law
I hereby apply for a permit to sell or transfer Restricted Use Pesticides in accordance with
regulations adopted under Section 21 of the Rules and Regulations of the Delaware Pesticide
Law.
PLEASE TYPE OR PRINT
Dealer Permit No.
Name of Contact Person
Contact Person/Phone Number
Dealership Name
Fax#
Address
City
State
Zip Code
I certify that I understand my legal responsibilities for the sale of Restricted Use
Pesticides and that I will sell Restricted Use Pesticides only to individuals who possess
a valid Pesticide Applicators Certificate.
Signature
Date
The annual fee for a Restricted Use Pesticide Dealer Permit is $25.00 and is payable to the Delaware
Department of Agriculture.
CHECK/MONEY ORDER
NEW!!!
CREDIT CARD
Fee - $25.00
Fee - $25.00
Visa
MasterCard
Discover
Billing Name:
Make Check or Money Order
Credit Card Billing
Address:
Payable to:
City/State/Zip:
*CVC# _____
Credit Card Number:
# is on the back of the card; 3 or 4
digits
Delaware Department of
/
Expiration Date:
Agriculture
Month
Year
Authorization:
Document No. 65-01-06/01/08/05
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