"Pest Control, Weed Control, Landscape Horticulturist, Tree Surgery Request to Change Company Name, Physical Address or Mailing Address" - Mississippi

Pest Control, Weed Control, Landscape Horticulturist, Tree Surgery Request to Change Company Name, Physical Address or Mailing Address is a legal document that was released by the Mississippi Department of Agriculture and Commerce - a government authority operating within Mississippi.

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PEST CONTROL, WEED CONTROL, LANDSCAPE HORTICULTURIST, TREE SURGERY
REQUEST TO CHANGE COMPANY NAME, PHYSICAL ADDRESS OR MAILING ADDRESS
RETURN THIS FORM WITH REQUIRED DOCUMENTS AND FORMS TO:
BUREAU OF PLANT INDUSTRY, P.O. BOX 5207, MISSISSIPPI STATE, MS 39762 PHONE: 662-325-3390
LEGIBLY PRINT OR TYPE
DATE OF REQUEST: ________________ COMPANY NUMBER _______________ YOUR ID NUMBER __________________
STATE COMPANY NAME, ADDRESS, CITY, STATE AND ZIP AS PRINTED ON CURRENT LICENSE/PERMIT
COMPANY NAME: ______________________________________________________________________________________
ADDRESS: ________________________________________________________ CITY: ______________________________
STATE: _________ ZIP: ______________ E-MAIL ADDRESS: __________________________________________________
I REQUEST TO CHANGE COMPANY NAME: YES □ NO □ (COMPLETE SECTION 1 AND SUBMIT THIS FORM)
I REQUEST TO CHANGE PHYSICAL ADDRESS: YES □ NO □ (COMPLETE SECTION 2 AND SUBMIT THIS FORM)
I REQUEST TO CHANGE MAILING ADDRESS: YES □ NO □ (COMPLETE SECTION 3 AND SUBMIT THIS FORM)
• SECTION 1: CHANGE OF COMPANY NAME (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● RETURN ALL CURRENT ORIGINAL LICENSES AND/OR PERMITS.
● RETURN REGISTERED TECHNICIAN IDENTIFICATION CARDS FOR ALL EMPLOYEES.
● SUBMIT APPLICATIONS FOR REGISTERED TECHNICIAN ID CARDS FOR ALL UNLICENSED/UNPERMITTED EMPLOYEES.
● SUBMIT BOND RIDER REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND PLANT DISEASE
CONTROL CATEGORIES, WEED CONTROL CATEGORIES AND LANDSCAPE HORTICULTURIST CATEGORY)
● SUBMIT CERTIFICATE OF INSURANCE REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND
PLANT DISEASE CONTROL CATEGORIES AND TREE SURGERY CATEGORY)
NEW COMPANY NAME: _________________________________________________________________________________
• SECTION 2: CHANGE OF PHYSICAL ADDRESS (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● RETURN ALL CURRENT ORIGINAL LICENSES AND/OR PERMITS.
● RETURN REGISTERED TECHNICIAN IDENTIFICATION CARDS FOR ALL EMPLOYEES.
● SUBMIT APPLICATIONS FOR NEW REGISTERED TECHNICIAN ID CARDS FOR ALL UNLICENSED/UNPERMITTED EMPLOYEES.
● SUBMIT BOND RIDER REFLECTING THE NEW ADDRESS (REQUIRED FOR ALL INSECT, RODENT AND PLANT DISEASE
CONTROL CATEGORIES, WEED CONTROL CATEGORIES AND LANDSCAPE HORTICULTURIST CATEGORY)
● SUBMIT CERTIFICATE OF INSURANCE REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND
PLANT DISEASE CONTROL CATEGORIES AND TREE SURGERY CATEGORY)
NEW PHYSICAL ADDRESS: _______________________________________________________________________________
(PHYSICAL ADDRESS, CITY, STATE, ZIP)
PHONE # FOR NEW ADDRESS: _______________________ FAX # FOR NEW ADDRESS: _____________________________
COUNTY OR PARRISH: _____________________________________________________
• SECTION 3: CHANGE OF MAILING ADDRESS (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● IF LICENSES AND/OR PERMITS FORMS AND REGISTERED TECHNICIAN ID CARDS FOR ALL EMPLOYEES, HAVE THE CORRECT
PHYSICAL ADDRESS, THIS FORM IS ALL THAT MUST BE RETURNED.
OLD MAILING ADDRESS: ____________________________________________________________________________________
(P.O. BOX, CITY, STATE, ZIP)
NEW MAILING ADDRESS: ___________________________________________________________________________________
(P.O. BOX, CITY, STATE, ZIP)
___________________________________________________________ ____________________________________________________________
PRINTED NAME OF LICENSEE
SIGNATURE OF LICENSEE (REQUIRED)
FORM REVISED AUG. 2013
PEST CONTROL, WEED CONTROL, LANDSCAPE HORTICULTURIST, TREE SURGERY
REQUEST TO CHANGE COMPANY NAME, PHYSICAL ADDRESS OR MAILING ADDRESS
RETURN THIS FORM WITH REQUIRED DOCUMENTS AND FORMS TO:
BUREAU OF PLANT INDUSTRY, P.O. BOX 5207, MISSISSIPPI STATE, MS 39762 PHONE: 662-325-3390
LEGIBLY PRINT OR TYPE
DATE OF REQUEST: ________________ COMPANY NUMBER _______________ YOUR ID NUMBER __________________
STATE COMPANY NAME, ADDRESS, CITY, STATE AND ZIP AS PRINTED ON CURRENT LICENSE/PERMIT
COMPANY NAME: ______________________________________________________________________________________
ADDRESS: ________________________________________________________ CITY: ______________________________
STATE: _________ ZIP: ______________ E-MAIL ADDRESS: __________________________________________________
I REQUEST TO CHANGE COMPANY NAME: YES □ NO □ (COMPLETE SECTION 1 AND SUBMIT THIS FORM)
I REQUEST TO CHANGE PHYSICAL ADDRESS: YES □ NO □ (COMPLETE SECTION 2 AND SUBMIT THIS FORM)
I REQUEST TO CHANGE MAILING ADDRESS: YES □ NO □ (COMPLETE SECTION 3 AND SUBMIT THIS FORM)
• SECTION 1: CHANGE OF COMPANY NAME (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● RETURN ALL CURRENT ORIGINAL LICENSES AND/OR PERMITS.
● RETURN REGISTERED TECHNICIAN IDENTIFICATION CARDS FOR ALL EMPLOYEES.
● SUBMIT APPLICATIONS FOR REGISTERED TECHNICIAN ID CARDS FOR ALL UNLICENSED/UNPERMITTED EMPLOYEES.
● SUBMIT BOND RIDER REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND PLANT DISEASE
CONTROL CATEGORIES, WEED CONTROL CATEGORIES AND LANDSCAPE HORTICULTURIST CATEGORY)
● SUBMIT CERTIFICATE OF INSURANCE REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND
PLANT DISEASE CONTROL CATEGORIES AND TREE SURGERY CATEGORY)
NEW COMPANY NAME: _________________________________________________________________________________
• SECTION 2: CHANGE OF PHYSICAL ADDRESS (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● RETURN ALL CURRENT ORIGINAL LICENSES AND/OR PERMITS.
● RETURN REGISTERED TECHNICIAN IDENTIFICATION CARDS FOR ALL EMPLOYEES.
● SUBMIT APPLICATIONS FOR NEW REGISTERED TECHNICIAN ID CARDS FOR ALL UNLICENSED/UNPERMITTED EMPLOYEES.
● SUBMIT BOND RIDER REFLECTING THE NEW ADDRESS (REQUIRED FOR ALL INSECT, RODENT AND PLANT DISEASE
CONTROL CATEGORIES, WEED CONTROL CATEGORIES AND LANDSCAPE HORTICULTURIST CATEGORY)
● SUBMIT CERTIFICATE OF INSURANCE REFLECTING THE NEW COMPANY NAME (REQUIRED FOR ALL INSECT, RODENT AND
PLANT DISEASE CONTROL CATEGORIES AND TREE SURGERY CATEGORY)
NEW PHYSICAL ADDRESS: _______________________________________________________________________________
(PHYSICAL ADDRESS, CITY, STATE, ZIP)
PHONE # FOR NEW ADDRESS: _______________________ FAX # FOR NEW ADDRESS: _____________________________
COUNTY OR PARRISH: _____________________________________________________
• SECTION 3: CHANGE OF MAILING ADDRESS (TO AVOID DELAYS IN PROCESSING FOLLOW DIRECTIONS)
● IF LICENSES AND/OR PERMITS FORMS AND REGISTERED TECHNICIAN ID CARDS FOR ALL EMPLOYEES, HAVE THE CORRECT
PHYSICAL ADDRESS, THIS FORM IS ALL THAT MUST BE RETURNED.
OLD MAILING ADDRESS: ____________________________________________________________________________________
(P.O. BOX, CITY, STATE, ZIP)
NEW MAILING ADDRESS: ___________________________________________________________________________________
(P.O. BOX, CITY, STATE, ZIP)
___________________________________________________________ ____________________________________________________________
PRINTED NAME OF LICENSEE
SIGNATURE OF LICENSEE (REQUIRED)
FORM REVISED AUG. 2013