"Farm Products Dealer License Application Form With Cash Buyer Affidavit" - Colorado

Farm Products Dealer License Application Form With Cash Buyer Affidavit is a legal document that was released by the Colorado Department of Agriculture - a government authority operating within Colorado.

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Download "Farm Products Dealer License Application Form With Cash Buyer Affidavit" - Colorado

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Farm Products Program: (303) 477-0054
Farm Products Dealer License Application
With Cash Buyer Bond Declaration
January 1 – December 31 __________ (Year)
Application Fee:
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$25.00
st
(4610) Penalty (after Dec. 31
) $25.00
$______
Mail payment and
Colorado Dept. of Agriculture/ ICS
application to:
st
2331 West 31
Avenue
Total amount enclosed
$______
Denver, CO 80211
All payments must be payable in U.S. dollars and checks must be drawn on a U.S. bank or the payment and this form will be returned.
Note: Applicant’s name and address must match Legal Business Name
1. Business Name of Applicant:
2. Principal Business Address:
Mailing Address (if different):
3. Phone Number:
County:
4. Email Address:
5. (Check one) This business is operating as a(n): __ Individual/Sole Proprietorship* __ Partnership __Corporation
__ Other (Describe): ______________________________________________________________________________
*If you are operating as an individual/sole proprietorship, you must complete the “Citizenship/Immigration Status Verification Form”
6. State kind(s) of farm products handled: ______________________________________________________________
7. Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively? Yes:__ No:__
8. Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
9. Do you have an agent representing your firm in Colorado?
Yes:__ No:__
10. List person(s) authorized to receive and accept service of summons and legal notices of all kinds for the applicant
in the state of Colorado. (Name and complete address)
Name: _________________________________ Address: ___________________________________________________
I understand that as a dealer I must comply with all requirements of the Farm Products Act (Title 35, Article 37, Sections 101
et. Seq. C.R.S.). I understand that making false statements on this application is punishable by law.
I certify that all the statements made in this application are true, correct, and complete to the best of my knowledge and
belief, and are made in good faith.
Legal Name of Applicant:
Date:
Signature:
Cash Buyers Bond Declaration
I/We whose name, business address, and mailing address is listed above, state that it is my/our desire to engage in the business of buying farm products, as defined in
subsection 35-37-103(8), C.R.S. (2017), in cash, with bank certified check, bank cashier’s check or postal or Western Union money order; and execute this Cash Buyer
Bond Declaration for filing with the Commissioner of the Colorado Department of Agriculture for the purpose of exemption from compliance with subsection 35-37(1)(a),
C.R.S. (2017)
I/We further state: That should any other method for payment for Colorado farm products be made by me/us, except as set forth in subsection 35-37-106(1)(e), C.R.S.
(2017), I/we will be subject to compliance with section 35-37-106, C.R.S. (2017) including but not limited to filing with the Commissioner a bond of irrevocable letter of
credit.
I/We have read and fully understand the contents of the foregoing statements and they are true and correct to the best of my/our knowledge.
Date: _______________________ Signature: _______________________________________________________
Farm Products Program: (303) 477-0054
Farm Products Dealer License Application
With Cash Buyer Bond Declaration
January 1 – December 31 __________ (Year)
Application Fee:
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$25.00
st
(4610) Penalty (after Dec. 31
) $25.00
$______
Mail payment and
Colorado Dept. of Agriculture/ ICS
application to:
st
2331 West 31
Avenue
Total amount enclosed
$______
Denver, CO 80211
All payments must be payable in U.S. dollars and checks must be drawn on a U.S. bank or the payment and this form will be returned.
Note: Applicant’s name and address must match Legal Business Name
1. Business Name of Applicant:
2. Principal Business Address:
Mailing Address (if different):
3. Phone Number:
County:
4. Email Address:
5. (Check one) This business is operating as a(n): __ Individual/Sole Proprietorship* __ Partnership __Corporation
__ Other (Describe): ______________________________________________________________________________
*If you are operating as an individual/sole proprietorship, you must complete the “Citizenship/Immigration Status Verification Form”
6. State kind(s) of farm products handled: ______________________________________________________________
7. Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively? Yes:__ No:__
8. Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
9. Do you have an agent representing your firm in Colorado?
Yes:__ No:__
10. List person(s) authorized to receive and accept service of summons and legal notices of all kinds for the applicant
in the state of Colorado. (Name and complete address)
Name: _________________________________ Address: ___________________________________________________
I understand that as a dealer I must comply with all requirements of the Farm Products Act (Title 35, Article 37, Sections 101
et. Seq. C.R.S.). I understand that making false statements on this application is punishable by law.
I certify that all the statements made in this application are true, correct, and complete to the best of my knowledge and
belief, and are made in good faith.
Legal Name of Applicant:
Date:
Signature:
Cash Buyers Bond Declaration
I/We whose name, business address, and mailing address is listed above, state that it is my/our desire to engage in the business of buying farm products, as defined in
subsection 35-37-103(8), C.R.S. (2017), in cash, with bank certified check, bank cashier’s check or postal or Western Union money order; and execute this Cash Buyer
Bond Declaration for filing with the Commissioner of the Colorado Department of Agriculture for the purpose of exemption from compliance with subsection 35-37(1)(a),
C.R.S. (2017)
I/We further state: That should any other method for payment for Colorado farm products be made by me/us, except as set forth in subsection 35-37-106(1)(e), C.R.S.
(2017), I/we will be subject to compliance with section 35-37-106, C.R.S. (2017) including but not limited to filing with the Commissioner a bond of irrevocable letter of
credit.
I/We have read and fully understand the contents of the foregoing statements and they are true and correct to the best of my/our knowledge.
Date: _______________________ Signature: _______________________________________________________