Form A "Pesticide Business License Renewal" - Delaware

Form A or the "Pesticide Business License Renewal" is a form issued by the Delaware Department of Agriculture.

The form was last revised in August 4, 2001 and is available for digital filing. Download an up-to-date Form A in PDF-format down below or look it up on the Delaware Department of Agriculture Forms website.

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Download Form A "Pesticide Business License Renewal" - Delaware

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FOR OFFICE USE ONLY
Business License #
Certified App. #
Delaware Department of Agriculture
Ins. Expiration
Service Employee(s)
Y / N
Pesticides Section
Telephone
(302) 698-4500
Category(ies)
2320 S. DuPont Hwy.
DE Only
(800) 282-8685
Approval
Dover, DE 19901
Fax No.
(302) 697-4483
PESTICIDE BUSINESS LICENSE RENEWAL, FORM A
Your current Pesticide License expires December 31, 2016. Please complete items 1 – 5. Return the signed
application along with the fee payment to the above address.
1.
Circle the Applicator Category
1A
Agricultural Plant
5A
Aquatic
7D
Wood Preservatives
1B
Agricultural Animal
5B
Antifouling Paint
7E
Institutional and Maintenance Pest Ctrl.
1C
Fumigation of Soil & Ag.
5C
Mosquito
7F
Cooling Tower Pest Control
02
Forest
06
Right-of-Way
7G
Miscellaneous Pest Control
03
Ornamental & Turf
7A
General Pest Control
08
Public Health
04
Seed Treatment
7B
Wood Destroying Pest Control
09
Regulatory
7C
Fumigation Pest Control
10
Demonstration & Research
2.
Business Name & Mailing Address:
3.
Physical address of business if different from mailing
address:
Owner/Manager’s Name
Company Name
Address
City, State and Zip Code
Phone Number
E-mail Address (optional)
4.
Signatures
Print Manager’s Name
Manager’s Signature
Date
5.
Fee – Check or Money order
Fee – Credit Card
$50 for one year license
$50 for one year license
Visa
MasterCard
Discover
Billing Name:
Credit Card Billing
Make Check or Money Order
Address:
Payable to:
City/State/Zip:
*CVC#
Credit Card Number:
Delaware Department of Agriculture
/
/
Expiration Date
Authorization
Document No. 65-01-06/01/08/04 *This number can be found on the back of card near signature.
FOR OFFICE USE ONLY
Business License #
Certified App. #
Delaware Department of Agriculture
Ins. Expiration
Service Employee(s)
Y / N
Pesticides Section
Telephone
(302) 698-4500
Category(ies)
2320 S. DuPont Hwy.
DE Only
(800) 282-8685
Approval
Dover, DE 19901
Fax No.
(302) 697-4483
PESTICIDE BUSINESS LICENSE RENEWAL, FORM A
Your current Pesticide License expires December 31, 2016. Please complete items 1 – 5. Return the signed
application along with the fee payment to the above address.
1.
Circle the Applicator Category
1A
Agricultural Plant
5A
Aquatic
7D
Wood Preservatives
1B
Agricultural Animal
5B
Antifouling Paint
7E
Institutional and Maintenance Pest Ctrl.
1C
Fumigation of Soil & Ag.
5C
Mosquito
7F
Cooling Tower Pest Control
02
Forest
06
Right-of-Way
7G
Miscellaneous Pest Control
03
Ornamental & Turf
7A
General Pest Control
08
Public Health
04
Seed Treatment
7B
Wood Destroying Pest Control
09
Regulatory
7C
Fumigation Pest Control
10
Demonstration & Research
2.
Business Name & Mailing Address:
3.
Physical address of business if different from mailing
address:
Owner/Manager’s Name
Company Name
Address
City, State and Zip Code
Phone Number
E-mail Address (optional)
4.
Signatures
Print Manager’s Name
Manager’s Signature
Date
5.
Fee – Check or Money order
Fee – Credit Card
$50 for one year license
$50 for one year license
Visa
MasterCard
Discover
Billing Name:
Credit Card Billing
Make Check or Money Order
Address:
Payable to:
City/State/Zip:
*CVC#
Credit Card Number:
Delaware Department of Agriculture
/
/
Expiration Date
Authorization
Document No. 65-01-06/01/08/04 *This number can be found on the back of card near signature.
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