Application For Pest Control Employee-Identification Card Form - Florida Department Of Agriculture And Consumer Services Page 2

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Florida Department of Agriculture and Consumer Services
Remit Fee Online at:
Division of Agricultural Environmental Services
- or -
APPLICATION FOR PEST CONTROL
Check or Money Order Payable to
FDACS:
EMPLOYEE-IDENTIFICATION CARD
Bureau of Licensing and Enforcement
ADAM H. PUTNAM
Rule 5E-14.142, F.A.C.
Revenue Processing Section
COMMISSIONER
Telephone: (850) 617-7997
407 S. Calhoun Street, Room 121
Tallahassee, FL 32399-0800
: ___________________________________________________________________JB Number: ___________________
NAME OF BUSINESS
_______________________________________________________________________________________
COMPLETE NAME OF EMPLOYEE:
(Last)
(First)
(Middle)
This page must be included
with application submittal.
Org. Code: 42 13 08 02 060
EO B7
Object Code: 002251
$ 10.00
002241
$ 10.00
001371
$ 10.00
FDACS-13606 Rev. 07/14
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