Form SPCS-13-20 "Application for Structural Pest Control Company License" - Georgia (United States)

What Is Form SPCS-13-20?

This is a legal form that was released by the Georgia Department of Agriculture - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Georgia Department of Agriculture;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SPCS-13-20 by clicking the link below or browse more documents and templates provided by the Georgia Department of Agriculture.

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Download Form SPCS-13-20 "Application for Structural Pest Control Company License" - Georgia (United States)

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Structural Pest Section
Telephone: (404) 656-3641
INSTRUCTIONS FOR COMPLETING THE COMPANY LICENSE APPLICATION
APPLICANT INFORMATION
This person might be the same person as the designated certified operator.
COMPANY INFORMATION
You may submit more than one company name to be considered. The Commission
may reject a name, if it is likely to be confused with a previously issued name
(Chapter 620-2-.01 of the Rules of the Georgia Structural Pest Control Act).
LICENSE INFORMATION
Check the appropriate box for the operational categories of structural pest control
and type of license. A sub-office license is limited to any office of a licensee having
only one registered employee who is under the charge of the Designated Certified
Operator in the main licensed office. A Designated Certified Operator is a person who
is currently certified in one or more of the Structural Pest Control categories and has
been designated by a licensee as being responsible for the pest control and reporting
activities of licensee in the category(ies) in which operator is certified.
FEES SUBMITTED
Fees required are listed on the application. Be sure to indicate the amount paid and
to include a check or money order for the correct amount. Applications received
without payments will be returned.
INSURANCE INFORMATION
The license will not be issued without proof of insurance. The insurance form must
have the approved company name. A company representative must complete the
form, and it can be mailed or faxed to the Structural Pest Control Office.
APPLICANT AND DESIGNATED CERTIFIED OPERATOR
All applicable individuals must sign application.
Unsigned applications will be
returned.
Applications received by the 1
day of the month will be considered by the
st
Commission at their monthly meeting.
www.agr.georgia.gov
SPCS-13-20
Structural Pest Section
Telephone: (404) 656-3641
INSTRUCTIONS FOR COMPLETING THE COMPANY LICENSE APPLICATION
APPLICANT INFORMATION
This person might be the same person as the designated certified operator.
COMPANY INFORMATION
You may submit more than one company name to be considered. The Commission
may reject a name, if it is likely to be confused with a previously issued name
(Chapter 620-2-.01 of the Rules of the Georgia Structural Pest Control Act).
LICENSE INFORMATION
Check the appropriate box for the operational categories of structural pest control
and type of license. A sub-office license is limited to any office of a licensee having
only one registered employee who is under the charge of the Designated Certified
Operator in the main licensed office. A Designated Certified Operator is a person who
is currently certified in one or more of the Structural Pest Control categories and has
been designated by a licensee as being responsible for the pest control and reporting
activities of licensee in the category(ies) in which operator is certified.
FEES SUBMITTED
Fees required are listed on the application. Be sure to indicate the amount paid and
to include a check or money order for the correct amount. Applications received
without payments will be returned.
INSURANCE INFORMATION
The license will not be issued without proof of insurance. The insurance form must
have the approved company name. A company representative must complete the
form, and it can be mailed or faxed to the Structural Pest Control Office.
APPLICANT AND DESIGNATED CERTIFIED OPERATOR
All applicable individuals must sign application.
Unsigned applications will be
returned.
Applications received by the 1
day of the month will be considered by the
st
Commission at their monthly meeting.
www.agr.georgia.gov
SPCS-13-20
Georgia Department of Agriculture
Structural Pest Control Section
19 Martin Luther King, Jr. Drive, Room 411
Atlanta, Georgia 30334-4201
Official Use Only
APPLICATION FOR STRUCTURAL PEST CONTROL COMPANY LICENSE
Voucher
Amount
$
APPLICANT INFORMATION
Applicant’s Name
COMPANY INFORMATION
Company Name
County
Street Address
Mailing Address (if different from street Address)
City
State
Zip
City
State
Zip
Telephone Number
Fax Number
Website
Email
License Information
Check license
Fumigation (28)
Household Pest (29)
Wood-destroying Organism (30)
categories
Name
Name
Name
Designated
Certified
Operator(s)
Certification #
Certification #
Certification #
Type of License
Company License
Sub-Office License
Main Office License Number
(check one)
Fees Submitted (Can be paid by Check or Money Order)
$10.00 for each Employee Registration (Employees who have taken and passed the registration exam, excluding certified
operators). Complete and attach the Application for Employee Registration Cards.
$100.00 Company
$70.00 Research Fee
$10.00 Sub-Office License
Enter Total Fee enclosed
License Fee
INSURANCE INFORMATION
The license can not be issued without proof of insurance. Insurance Form must be completed by
Attached
Submitted
an insurance agent.
separately
APPLICANT AND DESIGNATED CERTIFIED OPERATOR
I hereby certify that the information given in this application is true and correct.
Signature of Applicant
Date
Signature of Designated Certified Operator(s)
Date
Certification #
Signature of Chairman of Structural Pest Control Commission
Date
No
Yes/Pending
SPCS-13-20
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