"Initial Application for Pesticide Dealer License" - Louisiana

Initial Application for Pesticide Dealer License is a legal document that was released by the Louisiana Department of Agriculture & Forestry - a government authority operating within Louisiana.

Form Details:

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Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Louisiana Department of Agriculture & Forestry.

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Download "Initial Application for Pesticide Dealer License" - Louisiana

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L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
Mike Strain DVM, Commissioner
Agricultural & Environmental Sciences, 5825 Florida Blvd, Baton Rouge, LA 70806, Phone (225) 925-3796
2020 INITIAL APPLICATION FOR PESTICIDE DEALER LICENSE
Owner/Principal Officer:
Company Name:
Mailing Address:
-
City/State/Zip:
Physical Address:
City/State/Zip:
00
LOUISIANA RESIDENT PESTICIDE DEALER LICENSE FEE $200
LOUISIANA NON-RESIDENT PESTICIDE DEALER LICENSE FEE $500
00
$
00
AMOUNT DUE =
$
00
INSTRUCTIONS:
Must employ at least one Louisiana certified Sales Person OR Commercial Pesticide Applicator and
provide their information on Page 2.
Do not staple payment to your application! Checks or Money Orders are the only accepted methods of
payment. DO NOT MAIL CASH! Make payable to:
LOUISIANA DEPARTMENT OF AGRICULTURE & FORESTRY
Mail to: Louisiana Dept. of Agriculture & Forestry, 5825 Florida Blvd., Ste. 1003, Baton Rouge, LA 70806
Print Name
Signature
Date
AES-07-07(r.12/19)
OFFICE USE
Transmittal #
Check #
RESIDENT
0800 1605 01__
NON RESIDENT 0800 1605 N1__
Date
$
Amt.
.00
LDAF ID No.: (Office Use Only)
Page 1 of 2
L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
Mike Strain DVM, Commissioner
Agricultural & Environmental Sciences, 5825 Florida Blvd, Baton Rouge, LA 70806, Phone (225) 925-3796
2020 INITIAL APPLICATION FOR PESTICIDE DEALER LICENSE
Owner/Principal Officer:
Company Name:
Mailing Address:
-
City/State/Zip:
Physical Address:
City/State/Zip:
00
LOUISIANA RESIDENT PESTICIDE DEALER LICENSE FEE $200
LOUISIANA NON-RESIDENT PESTICIDE DEALER LICENSE FEE $500
00
$
00
AMOUNT DUE =
$
00
INSTRUCTIONS:
Must employ at least one Louisiana certified Sales Person OR Commercial Pesticide Applicator and
provide their information on Page 2.
Do not staple payment to your application! Checks or Money Orders are the only accepted methods of
payment. DO NOT MAIL CASH! Make payable to:
LOUISIANA DEPARTMENT OF AGRICULTURE & FORESTRY
Mail to: Louisiana Dept. of Agriculture & Forestry, 5825 Florida Blvd., Ste. 1003, Baton Rouge, LA 70806
Print Name
Signature
Date
AES-07-07(r.12/19)
OFFICE USE
Transmittal #
Check #
RESIDENT
0800 1605 01__
NON RESIDENT 0800 1605 N1__
Date
$
Amt.
.00
LDAF ID No.: (Office Use Only)
Page 1 of 2
2020 INITIAL APPLICATION FOR PESTICIDE DEALER (RUP) LICENSE - Page 2
Louisiana Certified Sales Persons or Commercial Applicators If no card has been renewed for the current year, license will be delayed.
May Add Second Page If Too Many To List
PLEASE CHECK BOX FOR ALL PERSONNEL TO BE INCLUDED ON APPLICATION
Name
Address
LDAF ID
Certifications
Card Expires
NOTES:
Resident means any person who has been domiciled in Louisiana for 90 days or longer.
Non-Resident means any person who is not a resident. If you are registered with the Secretary of State as an out of state corporation,
you are a non-resident.
LDAF ID No.: (Office Use Only)
Page 2 of 2
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