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"
Email*
example@example.com
Fax
"Enter Numbers Only"
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 be submitted via our online USAPlants system, emailed to feedprogram@ldaf.state.la.us, or disk/flash drive may be mailed to the below address.

• Do not staple payment to your application. Payment may be submitted via online transaction, 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*

Clear
Date*

MonthDayYear
Number of labels*
Total Due
Should be Empty: