Form PI-007 "Restricted Use Pesticide Dealer License Application" - Michigan

What Is Form PI-007?

This is a legal form that was released by the Michigan Department of Agriculture and Rural Development - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Michigan Department of Agriculture and Rural Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PI-007 by clicking the link below or browse more documents and templates provided by the Michigan Department of Agriculture and Rural Development.

ADVERTISEMENT
ADVERTISEMENT

Download Form PI-007 "Restricted Use Pesticide Dealer License Application" - Michigan

742 times
Rate (4.8 / 5) 37 votes
PI-007 (10/17)
Michigan Department of Agriculture & Rural Development
P.O. Box 30776, Lansing, MI 48909-8246 • 517-284-5771
FAX: 517-284-0458
In accordance with 1994 Public Act 451.
Restricted Use Pesticide Dealer License Application
License Year Ending: December 31 _______
Status:
New
Renewal
No Longer Needed
Business Information
Business Name:__________________________________________________________
Street Address:___________________________________________________________
City:________________________________________________ State: ______________
County:______________________________________________ Zip: _______________
Business Phone: (_____)_____________ Business Fax: (_____)___________________
Blank Space
Business Email: __________________________________________________________
For Offi cial Use Only
Mailing address if different from above: Street or P.O. Box:_________________________
_______________________________________________________________________________________________________
City:_____________________________________ State:______ County:__________________________ Zip:_______________
Corporate/Owner Information
Ownership Type:
Corporation
Sole Ownership
Partnership
L.L.C.
Other: Specify____________________
Corporation Name:_________________________________________________________________________________________
Street Address of Corporation:________________________________________________________________________________
City:_______________________________________________________________________ State: _______ Zip: _____________
Phone: (_____)_____________ Fax: (_____)_______________ Email: _______________________________________________
Federal/Tax ID #
For Offi cial Use Only
______________
_______________
Approved:
Date License Issued:
________________
__________________
Score:
Corporate ID #:
License Fees
(Non-refundable)
AOBJ: 0190
Dealer License Fee
$100
Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _______________
Please make check/money order payable to the State of Michigan and submit to the address at the top of the page.
Person in Charge Signature:_________________________________________________ Date:_____________________________
Please print your name here:__________________________________________________________
Application continues
Title:___________________________________________________
on the back of this form
www.michigan.gov/mda-licensing
PI-007 (10/17)
Michigan Department of Agriculture & Rural Development
P.O. Box 30776, Lansing, MI 48909-8246 • 517-284-5771
FAX: 517-284-0458
In accordance with 1994 Public Act 451.
Restricted Use Pesticide Dealer License Application
License Year Ending: December 31 _______
Status:
New
Renewal
No Longer Needed
Business Information
Business Name:__________________________________________________________
Street Address:___________________________________________________________
City:________________________________________________ State: ______________
County:______________________________________________ Zip: _______________
Business Phone: (_____)_____________ Business Fax: (_____)___________________
Blank Space
Business Email: __________________________________________________________
For Offi cial Use Only
Mailing address if different from above: Street or P.O. Box:_________________________
_______________________________________________________________________________________________________
City:_____________________________________ State:______ County:__________________________ Zip:_______________
Corporate/Owner Information
Ownership Type:
Corporation
Sole Ownership
Partnership
L.L.C.
Other: Specify____________________
Corporation Name:_________________________________________________________________________________________
Street Address of Corporation:________________________________________________________________________________
City:_______________________________________________________________________ State: _______ Zip: _____________
Phone: (_____)_____________ Fax: (_____)_______________ Email: _______________________________________________
Federal/Tax ID #
For Offi cial Use Only
______________
_______________
Approved:
Date License Issued:
________________
__________________
Score:
Corporate ID #:
License Fees
(Non-refundable)
AOBJ: 0190
Dealer License Fee
$100
Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _______________
Please make check/money order payable to the State of Michigan and submit to the address at the top of the page.
Person in Charge Signature:_________________________________________________ Date:_____________________________
Please print your name here:__________________________________________________________
Application continues
Title:___________________________________________________
on the back of this form
www.michigan.gov/mda-licensing
MICHIGAN DEPARTMENT OF AGRICULTURE AND RURAL DEVELOPMENT
RESTRICTED USE PESTICIDE DEALER LICENSE
INSTRUCTIONS
GENERAL INSTRUCTIONS:
1.
Complete the application.
2.
Enclose a check or money order for $100 payable to the STATE OF MICHIGAN
to the address at the top of the application. A $100 license fee is required for all
or any part of a calendar year.
The “Person in Charge” must sign the license application. A person
3.
designated by the company applying for the license to sell restricted use
pesticides (RUP’s) shall pass a written examination to determine his or her
knowledge of the laws and rules governing the use and sale of pesticides and
his or her responsibility in carrying on the business of a RUP dealer. This
person is referred to as the "Person in Charge." This individual must have
taken the RUP Dealer Exam before the firm can be licensed. NOTE: A person
who has previously taken/passed the RUP Dealer Examination is not required to
take the exam again. Please Contact Stephanie Baughan at (517) 284-5749 if
you have questions.
4.
Out of State applicants must contact the department at (517) 284-5659 or email
Antonio Escobar at
escobara@michigan.gov
regarding becoming licensed to
distribute RUP Products in Michigan.
5.
The firm needs to be registered with the State of Michigan to do business, if the
business is a Michigan corporation (including limited liability corporation), fill in
your current incorporation ID# in the Corporate/Assumed Name ID# box.
NOTE: Out of state companies must also be authorized to conduct business in
the State of Michigan. A copy of that authorization must be on file with the
Michigan Department of Agriculture and Rural Development. You can apply for
this authorization at the Michigan Department of Licensing and Regulatory
Affairs (LARA), Michigan Corporation Division (MCD), telephone (517) 241-6470
or for more information go to LARA’s website at
www.michigan.gov/corporations
QUESTIONS:
For information on materials to complete the examination and licensing procedures,
please contact Stephanie Baughan in the Central Licensing Unit at (517) 284-5749 or
e-mail Stephanie at
baughans9@michigan.gov
Page of 2