AHS-17-08 LOUISIANA ANIMAL FEED AND PET FOOD REGISTRATION APPLICATION

LOUISIANA ANIMAL FEED AND PET FOOD REGISTRATION APPLICATION
{Pursuant to Louisiana Revised Statutes Title 3, Chapter 10-A, Part II, §1393 (A)}
Business Name
Physical Address
City
State
Zip
Parish/County
License Number or USA Plants ID
Phone
"Enter Numbers Only"Format: (000) 000-0000.
Email
example@example.com
Fax
"Enter Numbers Only"Format: (000) 000-0000.
Mailing Address
City
State
Zip
Parish/County
Complete Name of Feed

0/100
• All labels must be submitted, reviewed, and approved by the Feed Program prior to distribution within Louisiana.

• Labels may emailed to feedprogram@ldaf.state.la.us, or disk/flash drive may be mailed to the below address.

• Payment may be submitted via check or money order. DO NOT MAIL CASH.

• Make payment to: LOUISIANA DEPARTMENT OF AGRICULTURE & FORESTRY.

• Mail to: LDAF Revenue, 5825 Florida Blvd., Suite 1003, Baton Rouge, LA 70806
Print Name
Signature
Date

MonthDayYear
Number of labels
Total Due
ONCE YOU CLICK SUBMIT, YOU WILL RECEIVE A CONFIRMATION EMAIL WITH YOUR RESPONSES. PLEASE MAIL A COPY OF YOUR EMAIL AND PAYMENT TO:

LDAF FEED PROGRAM C/O REVENUE, 5825 FLORIDA BLVD., SUITE 1003, BATON ROUGE, LA 70806
Should be Empty: