"Application for Pesticide Registration" - Delaware

Application for Pesticide Registration is a legal document that was released by the Delaware Department of Agriculture - a government authority operating within Delaware.

Form Details:

  • Released on May 1, 2003;
  • The latest edition currently provided by the Delaware 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 printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download "Application for Pesticide Registration" - Delaware

989 times
Rate (4.3 / 5) 69 votes
DELAWARE DEPARTMENT OF AGRICULTURE
APPLICATION FOR PESTICIDE REGISTRATION
In accordance with Title 3 Delaware Code , §1203, and the enclosed directions, application is
hereby made for the registration of the following pesticide(s) for a period of two years:
Number of new products:
(
attach list of products on separate sheet)
_____________
Number of renewed products: (
)
___________
see list attached
TOTAL number of products:
___________
TOTAL FEE: (
___________
Total number of products X $140.00)
PAYMENT OPTIONS: Enclose a check payable to the Delaware Department of Agriculture, or
complete the enclosed Credit Card Authorization Form.
SUBMISSION: Return completed application and accompanying information to Delaware
Department of Agriculture, Pesticides Section, 2320 S. Dupont Hwy., Dover, DE 19901
I hereby certify that the information contained in this Application is true and correct in
every respect; that each and every package of the attached list of products will be labeled
as described; and that the label declarations are guarantees as to the chemical composition
of the products listed for, and on behalf of:
Company Name:
Submitted by (Firm):
Mailing Address:
Phone:
City, State, Zip:
Date:
Print Name ___________________________________ Title ______________________
SIGNATURE _________________________________ Date _____________________
IMPORTANT: before application is approved the following items must be provided to the Department
for review:
ONE Complete and signed Application
Accurate and complete label for each product brand
List(s) of products on separate sheet(s) of paper, with EPA Registration Number
Payment of $140.00 for each pesticide brand or grade
FOR DEPARTMENT USE ONLY
Date received: ___________
Check Date: ___________
Check # _____________
Document Control #65-01-06/030501
DELAWARE DEPARTMENT OF AGRICULTURE
APPLICATION FOR PESTICIDE REGISTRATION
In accordance with Title 3 Delaware Code , §1203, and the enclosed directions, application is
hereby made for the registration of the following pesticide(s) for a period of two years:
Number of new products:
(
attach list of products on separate sheet)
_____________
Number of renewed products: (
)
___________
see list attached
TOTAL number of products:
___________
TOTAL FEE: (
___________
Total number of products X $140.00)
PAYMENT OPTIONS: Enclose a check payable to the Delaware Department of Agriculture, or
complete the enclosed Credit Card Authorization Form.
SUBMISSION: Return completed application and accompanying information to Delaware
Department of Agriculture, Pesticides Section, 2320 S. Dupont Hwy., Dover, DE 19901
I hereby certify that the information contained in this Application is true and correct in
every respect; that each and every package of the attached list of products will be labeled
as described; and that the label declarations are guarantees as to the chemical composition
of the products listed for, and on behalf of:
Company Name:
Submitted by (Firm):
Mailing Address:
Phone:
City, State, Zip:
Date:
Print Name ___________________________________ Title ______________________
SIGNATURE _________________________________ Date _____________________
IMPORTANT: before application is approved the following items must be provided to the Department
for review:
ONE Complete and signed Application
Accurate and complete label for each product brand
List(s) of products on separate sheet(s) of paper, with EPA Registration Number
Payment of $140.00 for each pesticide brand or grade
FOR DEPARTMENT USE ONLY
Date received: ___________
Check Date: ___________
Check # _____________
Document Control #65-01-06/030501