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Florida Department of Agriculture and Consumer Services

NICOLE "NIKKI" FRIED, Commissioner
Section 482.071, F.S., and Rule 5E-14.142, F.A.C.
Telephone: (850) 617-7997
Business Information
Business Name* (To be printed on your license) Business Type *
Firm's Legal Name, if different than Business Name FEID#*
Physical Address: * Line 2: Business City: * State: * Zip Code: *
Mailing (if different): Line 2: Mailing City: State: Zip Code:
Business Phone:* Fax Number: Email: *
List of owners OR corporate officers. Provide titles of corporate officers.
Designate Location
Designate location where pest control records and contracts of the this license will be kept and the exact location address for storage of chemicals if other than licenses business location: