Form 225 - Application For Registration
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4APPLICATION FOR REGISTRATION
APPROVED OMB NO 1117-0012
Form-225
FORM DEA-225 (04-12)
Under the Controlled Substances Act
FORM EXPIRES: 7/31/2018
Save time - apply on-line at
DEA OFFICIAL USE:
INSTRUCTIONS
1. To apply by mail complete this application. Keep a copy for your records.
2. Mail this form to the address provided in Section 7 or use enclosed envelope.
3. The "
" can be different than your "
" address.
MAIL-TO ADDRESS
PLACE OF BUSINESS
4. If you have any questions call 800-882-9539 prior to submitting your application.
Do you have other DEA registration numbers?
IMPORTANT: DO NOT SEND THIS APPLICATION AND APPLY ON-LINE.
NO
YES
FEE FOR ONE (1) YEAR - see Section 2
MAIL-TO ADDRESS
Please print mailing address changes to the right of the address in this box.
FEE IS NON-REFUNDABLE
SECTION 1
APPLICANT IDENTIFICATION
Individual Registration
Business Registration
Name 1
(Last Name of individual -OR- Business or Facility Name)
Name 2
(First Name and Middle Name of individual - OR- Continuation of business name)
PLACE OF BUSINESS Street Address Line 1
PLACE OF BUSINESS Address Line 2
City
State
Zip Code
Business Phone Number
Point of Contact
Business Fax Number
Email Address
Tax Identification Number
Social Security Number
DEBT COLLECTION
(if registration is for business)
(if registration is for individual)
INFORMATION
Mandatory pursuant
Provide TIN or SSN.
to Debt Collection
See additional information
Improvements Act
note #3 on page 4.
SECTION 2
Exporter..............................fee for one year is $1523
BUSINESS ACTIVITY
..
Researcher w/Sched I...........
.fee for one year is $244
Importer..............................fee for one year is $1523
Check one
business activity
box only
Researcher w/Sched II - V........fee for one year is $244
Reverse Distributor...........
fee for one year is $1523
..
Researcher -
Canine Handler.........................fee for one year is $244
Manufacturer......................fee for one year is $3047
See page 4
for required
.
.
attachments
Distributor...............................
.fee for one year is $1523
Manufacturer BULK..........
fee for one year is $3047
SECTION 3
manufacturers &
List 1 (L1)
Schedule 2 Narcotic
Schedule 3 Narcotic
Schedule 4
A. DRUG SCHEDULES
importers ONLY
Schedule 1
Schedule 2 Non-Narcotic (2N)
Schedule 3 Non-Narcotic (3N)
Schedule 5
Check all that apply
Enter drug codes on
Check this box if you require official order forms - for purchase of schedule 2 controlled substances.
page 2.
STAGE 3
1 2 2
3 3
4 5
1 2 2
3 3
4 5
B. MANUFACTURERS
STAGE 1
NON
NON
NON
NON
L1
L1
Package / Repackage
ONLY
Bulk synthesis/extraction
narcotic
narcotic
narcotic
narcotic
Label
/ Relabel
Mark each box with
an 'X' to indicate which
drug schedule is handled
1 2 2
3 3
4 5
1 2 2
3 3
4 5
STAGE 2
STAGE 4
NON
NON
NON
NON
L1
L1
in each manufacturing
Dosage form manufacture
Non-human consumption
narcotic
narcotic
narcotic
narcotic
stage
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