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Florida Department of Agriculture and Consumer Services

WILTON SIMPSON, Commissioner
LIMITED CERTIFICATION FOR URBAN LANDSCAPE COMMERCIAL FERTILIZER
Section 482.1562, F.S., and Rule 5E-14.117 F.A.C.
Applicant must be 18 years of age or older to apply. Fields marked with red asterisk are required. If Applicant has an existing license; name must be entered as listed on the licenses already in use. (Date Format: mm/dd/yyyy, Phone Format: 999-999-9999)
Applicant Information
First Name: * Middle Name: Last Name: * Suffix:
Date of Birth: * Name of Employer:
*
Email: * Business Email:
    Either home phone or cell phone is required. Format: 999-999-9999.
Home Phone: * Cell Phone: Business Phone: Fax Number:
Address Information
Home (Physical) Address: * Line 2: Home City: * State: * Zip Code: *
Mailing:* Line 2: Mailing City: * State: * Zip Code: *
Business Address:
*
 Line 2: Business City:
*
 State:
*
 Zip Code:
*