"Application for Professional Services License - Horticulture" - Alabama

Application for Professional Services License - Horticulture is a legal document that was released by the Alabama Department of Agriculture and Industries - a government authority operating within Alabama.

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Alabama Department of Agriculture and Industries
APPLICATION FOR PROFESSIONAL SERVICES LICENSE
HORTICULTURE
Date:
Return to:
DEPARTMENT OF AGRICULTURE & INDUSTRIES
PESTICIDE MANAGEMENT - PROFESSIONAL SERVICES
County:
1445 FEDERAL DRIVE
MONTGOMERY AL 36107-1123
AGI.ALABAMA.GOV
PHONE: 334-240-7269 FAX: 334-240-7316
Application for Professional Services License as required under provisions of Chapter 28, title2, Code of Alabama (1975) as amended.
LICENSE FEE: $175.00 FOR WORK CERTIFIED TO PERFORM. (FEE COVERS UP TO FOUR CATEGORIES). A
$50.00 DELINQUENT PENALTY WILL BE APPLIED IF APPLICATION IS NOT RECEIVED BY NOVEMBER 6. (PENALTY
does not apply to NEW BUSINESS.) EXISTING BUSINESSES REAPPLYING FOR A LICENSE MAY BE SUBJECT TO
CIVIL PENALTY PROVISIONS UP TO $3000.00 FOR PERFORMING OR SOLICITING PROFESSIONAL SERVICES
WORK WITHOUT A LICENSE.
IF APPLICATION IS SUBMITTED WITH OTHER LICENSE FEES, PLEASE SUBMIT SEPARATE CHECKS. CHECK
CERTIFIED CATEGORY(IES) BELOW:
Setting of Landscape Plants (SLP)
Landscape Design (LD)
Tree Surgery (TS)
Ornamental & Turf Pest Control (OTPS)
NAME OF BUSINESS:
!!CALL TO VERIFY NAME IS AVAILABLE!!
LOCATION:
PHONE 1:
)
(
ZIP CODE:
PHONE 2 (
MAILING ADDRESS:
)
ZIP CODE:
E-M AIL ADDRESS:
(
)
FAX #:
ADD-ON CATEGORY to License #
NEW BUSINESS
BUY OUT
RENEWAL
OUT OF BUSINESS
NAME CHANGE - OLD BUSINESS NAME:
LIST CERTIFIED SUPERVISOR(S) Additional names can be attached for those that passed exams and are certified.
NOTE:
ONLY THE OTPS CATEGORY HAS A COMMERCIAL CERTIFICATION NUMBER AND EXPIRATION DATE.
COMMERCIAL
CERTIFICATION
EXPIRATION
Last 4 SS # CERTIFICATION #
LEGAL NAME
D O B
CATEGORY
DATE
Partnership
Corporation* *
Sole Owner
APPLICANT WILL ENGAGE IN BUSINESS AS:
* * Corporation must be filed w/ the Secretary of State.
--
must verify company name w/Dept. of Agriculture first.
SIGNATURE:
TITLE:
APPLICATION MUST BE SIGNED. PLEASE MAKE CHECK PAYABLE TO THE ALABAMA DEPT OF AGRICULTURE
****************************** FOR OFFICE USE ONLY - DO NOT WRITE BELOW THIS LINE ********************************
License Fee:
LICENSE NUMBER:
Penalty:
Total:
Date Processed:
#
MO
Cash
Check
Alabama Department of Agriculture and Industries
APPLICATION FOR PROFESSIONAL SERVICES LICENSE
HORTICULTURE
Date:
Return to:
DEPARTMENT OF AGRICULTURE & INDUSTRIES
PESTICIDE MANAGEMENT - PROFESSIONAL SERVICES
County:
1445 FEDERAL DRIVE
MONTGOMERY AL 36107-1123
AGI.ALABAMA.GOV
PHONE: 334-240-7269 FAX: 334-240-7316
Application for Professional Services License as required under provisions of Chapter 28, title2, Code of Alabama (1975) as amended.
LICENSE FEE: $175.00 FOR WORK CERTIFIED TO PERFORM. (FEE COVERS UP TO FOUR CATEGORIES). A
$50.00 DELINQUENT PENALTY WILL BE APPLIED IF APPLICATION IS NOT RECEIVED BY NOVEMBER 6. (PENALTY
does not apply to NEW BUSINESS.) EXISTING BUSINESSES REAPPLYING FOR A LICENSE MAY BE SUBJECT TO
CIVIL PENALTY PROVISIONS UP TO $3000.00 FOR PERFORMING OR SOLICITING PROFESSIONAL SERVICES
WORK WITHOUT A LICENSE.
IF APPLICATION IS SUBMITTED WITH OTHER LICENSE FEES, PLEASE SUBMIT SEPARATE CHECKS. CHECK
CERTIFIED CATEGORY(IES) BELOW:
Setting of Landscape Plants (SLP)
Landscape Design (LD)
Tree Surgery (TS)
Ornamental & Turf Pest Control (OTPS)
NAME OF BUSINESS:
!!CALL TO VERIFY NAME IS AVAILABLE!!
LOCATION:
PHONE 1:
)
(
ZIP CODE:
PHONE 2 (
MAILING ADDRESS:
)
ZIP CODE:
E-M AIL ADDRESS:
(
)
FAX #:
ADD-ON CATEGORY to License #
NEW BUSINESS
BUY OUT
RENEWAL
OUT OF BUSINESS
NAME CHANGE - OLD BUSINESS NAME:
LIST CERTIFIED SUPERVISOR(S) Additional names can be attached for those that passed exams and are certified.
NOTE:
ONLY THE OTPS CATEGORY HAS A COMMERCIAL CERTIFICATION NUMBER AND EXPIRATION DATE.
COMMERCIAL
CERTIFICATION
EXPIRATION
Last 4 SS # CERTIFICATION #
LEGAL NAME
D O B
CATEGORY
DATE
Partnership
Corporation* *
Sole Owner
APPLICANT WILL ENGAGE IN BUSINESS AS:
* * Corporation must be filed w/ the Secretary of State.
--
must verify company name w/Dept. of Agriculture first.
SIGNATURE:
TITLE:
APPLICATION MUST BE SIGNED. PLEASE MAKE CHECK PAYABLE TO THE ALABAMA DEPT OF AGRICULTURE
****************************** FOR OFFICE USE ONLY - DO NOT WRITE BELOW THIS LINE ********************************
License Fee:
LICENSE NUMBER:
Penalty:
Total:
Date Processed:
#
MO
Cash
Check