The Tennessee Pesticides form is an essential application used to register pesticides for sale or distribution within the state. This form must be filed with the Commissioner of Agriculture and includes necessary documentation and fees. To ensure compliance, it is crucial to fill out this form accurately and submit it on time; click the button below to get started.
The Tennessee Pesticides form is a crucial document for businesses seeking to register pesticide products for sale or distribution within the state. This application must be filed with the Commissioner of Agriculture and includes essential details about the product, such as its brand name and EPA registration number. Each registration is valid until June 30 of the following year, requiring an annual fee of $100 for each product. If applications are submitted after the July 31 deadline, a late fee of $50 is incurred for each renewed or discontinued product. The form also necessitates the inclusion of both the registrant's and the correspondence firm's details, ensuring that the correct entities are identified for communication regarding the registration process. Applicants must certify the accuracy of the information provided, and the form allows for additional sheets if necessary. For those who wish to receive confirmation of their registration, a duplicate submission is recommended. Proper completion of this form is vital for compliance with state regulations and for the successful registration of pesticide products in Tennessee.
APPLICATION FOR THE REGISTRATION OF PESTICIDES IN TENNESSEE
This application is hereby filed with the Commissioner of Agriculture. The product(s) listed on the back are offered for sale or distribution within Tennessee and all fees and any required doucmentation are included. This registration shall be effective until June 30 of each year.
This fee is $100.00 for each product with a $50.00 late fee per renewed or discontinued product for applications received after July 31.
Enclosed is the annual registration fee of $_______________ for _______________ products.
Make your check payable to: TENNESSEE DEPARTMENT OF AGRICULTURE and send it to:TENNESSEE DEPARTMENT OF AGRICULTURE, Division of Consumer and Industry Services, P.O. Box 40627, Nashville, TN 37204, Attention: Pesticide Registration
REGISTRANT:
Firm: ___________________________________________
Address:___________________________________________
___________________________________________
Phone: ___________________________________________
Contact:___________________________________________
This should be the name and address of the company on the pesticide label.
Do not list by any other name on this section.
SEND CORRESPONDANCE TO:
Firm: _________________________________________
Address: _________________________________________
__________________________________________
Phone: __________________________________________
Contact:__________________________________________
This should be the company that will handle the registration for the above (e.g. parent firm, manufacturer, etc.).
If it is the same as the above, please list again.
I certify to the best of my knowledge that this application is true and accurate:
Signature and Date:_______________________________________________
DEPARTMENT USE ONLY
DATE OF APPROVAL:_________________________ STATE REGISTRANT NUMBER: _________________________
APPROVED:____________________________________________________
PESTICIDES TO BE REGISTERED IN TENNESSEE
Submit a duplicate if you wish to receive a copy from the Department verifying your registration. Please refer to the
cover sheet for instructions. Attach additional sheets if necessary.
EPA Registration Number:
Brand Name of Product (Please note if it is "RUP")
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