"Farm Products Dealer License Application" - Colorado

Farm Products Dealer License Application 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" - Colorado

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Farm Products Program: (303) 869-9102
Farm Products Dealer License Application
January 1 – December 31 __________ (Year)
Application Fee:
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$275.00
(4610) Penalty (after Dec. 31
st
) $50.00
$______
Colorado Dept. of Agriculture/ ICS
Mail payment and
application to:
305 Interlocken Parkway
Total amount enclosed
$______
Broomfield, CO 80021
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. Are you engaged in the business of BUYING farm products from Colorado producers or Dealers?
Yes:__ No:__
If YES, state your annual dollar volume of purchases of farm products from Colorado producers or dealers: $____________
8. Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively? Yes:__ No:__
9. Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
10. Do you have a Packers & Stockyards Act Bond? (Livestock Dealers Only):
Yes:__ No:__
Note: Out of state applicants must furnish the Commissioner documentary evidence of such bond.
11. Do you have an agent representing your firm in Colorado?
Yes:__ No:__
List all agents acting on your behalf on a separate sheet and attach to application.
12. 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: _____________________________________________________________
Farm Products Program: (303) 869-9102
Farm Products Dealer License Application
January 1 – December 31 __________ (Year)
Application Fee:
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$275.00
(4610) Penalty (after Dec. 31
st
) $50.00
$______
Colorado Dept. of Agriculture/ ICS
Mail payment and
application to:
305 Interlocken Parkway
Total amount enclosed
$______
Broomfield, CO 80021
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. Are you engaged in the business of BUYING farm products from Colorado producers or Dealers?
Yes:__ No:__
If YES, state your annual dollar volume of purchases of farm products from Colorado producers or dealers: $____________
8. Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively? Yes:__ No:__
9. Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
10. Do you have a Packers & Stockyards Act Bond? (Livestock Dealers Only):
Yes:__ No:__
Note: Out of state applicants must furnish the Commissioner documentary evidence of such bond.
11. Do you have an agent representing your firm in Colorado?
Yes:__ No:__
List all agents acting on your behalf on a separate sheet and attach to application.
12. 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: _____________________________________________________________