Form AG-00890 Application for Soil/Plant Amendment Product Registration - Minnesota

Form AG-00890 is a Minnesota Agriculture Department form also known as the "Application For Soil/plant Amendment Product Registration". The latest edition of the form was released in November 1, 2014 and is available for digital filing.

Download a PDF version of the Form AG-00890 down below or find it on Minnesota Agriculture Department Forms website.

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Pesticide & Fertilizer Management Division, Ph. 651-201-6379 Fax 651-201-6112
Minn. Stat. Sec. 18C.411
20______APPLICATION FOR SOIL/PLANT AMENDMENT PRODUCT REGISTRATION
License Period of January 1 to December 31
Do you currently hold a Minnesota Soil/Plant Amendment Product Registration Number:
No
Yes
If yes, MN Lic. No:__________________
GUARANTOR AS LABELED IN MINNESOTA (Complete below)
REGISTRANT (Complete if different from Guarantor)
Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Street Address:
Mailing Address:
City:
State:
City:
State:
Zip Code:
Zip Code:
Company Telephone:
Company Telephone:
COMPLETE BRAND NAME OF SOIL AND PLANT AMENDMENT
ITEM
Product registration WILL NOT be granted until product label/label fascimile and material used in promoting the sale of each product is
NO.
submitted with application.
1
2
3
4
5
6
7
8
9
10
Application Fees:
$__________________
Number of New Products ____________ X $200.00 each
Total Amount Due
600296(3100)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
For Office Use Only
I hereby certify that the information contained in and submitted with this form is true and correct.
Signature: ________________________________________
Date: ____________________
Name (Please print): ________________________________
Title: ____________________
Contact Telephone: ________________________ Fax Number: _______________________
E-mail Address: ______________________________________________________________
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651/201-6000. TTY users can
AG-00890 (11/14)
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.
Pesticide & Fertilizer Management Division, Ph. 651-201-6379 Fax 651-201-6112
Minn. Stat. Sec. 18C.411
20______APPLICATION FOR SOIL/PLANT AMENDMENT PRODUCT REGISTRATION
License Period of January 1 to December 31
Do you currently hold a Minnesota Soil/Plant Amendment Product Registration Number:
No
Yes
If yes, MN Lic. No:__________________
GUARANTOR AS LABELED IN MINNESOTA (Complete below)
REGISTRANT (Complete if different from Guarantor)
Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Street Address:
Mailing Address:
City:
State:
City:
State:
Zip Code:
Zip Code:
Company Telephone:
Company Telephone:
COMPLETE BRAND NAME OF SOIL AND PLANT AMENDMENT
ITEM
Product registration WILL NOT be granted until product label/label fascimile and material used in promoting the sale of each product is
NO.
submitted with application.
1
2
3
4
5
6
7
8
9
10
Application Fees:
$__________________
Number of New Products ____________ X $200.00 each
Total Amount Due
600296(3100)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
For Office Use Only
I hereby certify that the information contained in and submitted with this form is true and correct.
Signature: ________________________________________
Date: ____________________
Name (Please print): ________________________________
Title: ____________________
Contact Telephone: ________________________ Fax Number: _______________________
E-mail Address: ______________________________________________________________
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651/201-6000. TTY users can
AG-00890 (11/14)
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.

Download Form AG-00890 Application for Soil/Plant Amendment Product Registration - Minnesota

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