Bedding, Upholstered Furniture & Stuffed Toys Annual License Application Form

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BEDDING, UPHOLSTERED FURNITURE & STUFFED TOYS
ANNUAL LICENSE APPLICATION, PLEASE TYPE OR PRINT
OFFICE USE ONLY
Business Name__________________________________________________________________________
Ohio Registration Number
Address _______________________________________________________________________________
______________________________________________________________________________________
______________________
City _______________________________________________ St.__________ Zip___________________
Country _____________________________ County _________________________________________
Uniform Registry Number
Contact Name__________________________________________Phone ___________________________
__________________
Fax __________________________ E-Mail ________________________________________________
CIRCLE TYPE OF BUSINESS
FEES: Make Checks Payable To: Treasurer State of Ohio. Send
1) Manufacturer 2) Importer/ or Distributor
3) Wholesaler
check and application (Prepaid) to address listed on this form.
1) $50.00
Manufacturer, Importer/ or Distributor, Wholesaler,
4) Secondhand Dealer
5) Renovator
6) Auction House
Secondhand Dealer, Auction House, Mobile Home and
7) Recreational or Conversion Van Dealer
8) Mobile Home
Recreational Vehicle or Conversion Van Dealer
2) $35.00
Renovator
DESCRIBE TYPE OF ARTICLES
Does Applicant have other registration numbers?
YES_____________
NO_____________
If yes, list all numbers:
CHECK STATEMENTS WHICH APPLY
( ) Applicant is requesting an Ohio registration number.
If you already have a registration number from another state and you want Ohio to recognize that number do not check this box.
( ) Applicant is requesting recognition of another state’s registration number. List Number ____________________________
A copy of your current license certificate from the state you are requesting Ohio to recognize must be submitted with this application.
( ) Applicant is using only new materials in the manufacturing and/or renovation of their products.
( ) Applicant has sent a sample along with a copy of their application form, license certificate and law label as required by law.
A license will not be issued until your sample and law label have been approved at our laboratory.
Submit your sample and law label (Prepaid including custom duties and taxes, if any) to: OHIO BEDDING LABORATORY,
6606 Tussing Road, Reynoldsburg, OH 43068.
* A laboratory fee will be charged for each analysis and an invoice will be is sued with the report of analysis. For information
on submitting your samples, contact the lab at: Phone (614) 995-0773, Fax (614) 644-3217 Email:
OhioBedding@com.state.oh.us
NOTE: If you do not have a law label available for the item you are submitting, you may include a draft or proposed law label.
( )
Applicant is using secondhand materials in the manufacturing and/or renovation of their products.
A sample of your secondhand materials, copy of your application form and law label must be submitted to our laboratory for testing.
Submit your sample and law label (Prepaid) to: OHIO BEDDING LABORATORY, 6606 Tussing Road, Reynoldsburg, OH 43068
* Samples must meet sanitization requirements as prescribed in the Ohio Revised Code. Please contact the laboratory prior to
submitting a sample of secondhand material.
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ODOC Form 4003
Bureau of Operations & Maintenance - Bedding
614 | 644 2223
6606 Tussing Road
Fax
614 | 644 2428
PO Box 4009
TTY/TDD 800 | 750 0750
An Equal Opportunity Employer and Service Provider
Reynoldsburg, OH 43068-9009 U.S.A.

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