NEW SEED DEALER LICENSE APPLICATION
PHYSICAL LOCATION ADDRESS
Location Name
Address
City
State
Zip
Parish
Phone Number
Enter numbers only
Format: (000) 000-0000.
CORPORATE ADDRESS
Address
City
State
Zip
Phone Number
Enter numbers only
Format: (000) 000-0000.
Fax Number
Enter numbers only
Format: (000) 000-0000.
MAILING ADDRESS FOR LICENSE
Provide if different from Corporate Address
Name
Address
City
State
Zip
Phone Number
Enter numbers only
Format: (000) 000-0000.
Fax Number
Enter numbers only
Format: (000) 000-0000.
INSTRUCTIONS
Fee: $150.00 per year (July 1- June 30) for each place of business.
Mail completed application along with check or money order.
Make check payable to: Louisiana Department of Agriculture and Forestry, 5825 Florida Blvd., Suite 1003, Baton Rouge, LA 70806.
DO NOT SE
ND
CASH.
CONTACT PERSON
Name
First Name
Last Name
Suffix
Phone Number
Enter numbers only
Format: (000) 000-0000.
Email
example@example.com
Submit
Should be Empty: