PLEASE PRINT
FORM APPROVED
Information requested is needed to determine if a permit can be issued (7 CFR 319). See reverse for additional information.
OMB NO. 0579-0049
U.S. DEPARTMENT OF AGRICULTURE
1. Date of Application
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE
APPLICATION FOR PERMIT TO IMPORT PLANTS OR PLANT PRODUCTS
2. PLANTS OR PLANT PRODUCTS TO BE IMPORTED
COUNTRY OF ORIGIN
QUANTITY AND NAME OF PLANTS OR PLANT PRODUCTS
U.S. PORT OR PORTS
(If Canada, give city and province.
Scientific (Botanical) or English names must be included (colloquial names
OF ARRIVAL IF SHIPPED
If Mexico, give State.
are not acceptable).
OTHER THAN BY MAIL
Make separate entry for each country.)
List whether seeds, bulbs, plants, cuttings, cut flowers, fruits, etc.
Indicate whether for planting, consumption, or other purpose.
Use the reverse side of this form if more space is needed and “X” box
3. “X” MEANS OF IMPORTATION
Air Mail or Air Parcel Post
Air Freight
Car
Surface Mail or Parcel Post
Truck, Rail or Water Freight
Baggage
4. APPROXIMATE DATE OF DEPARTURE FROM U.S.A.
ARRIVAL DTE
5. ARE OTHER IMPORATIONS CONTEMPLATED WITHIN THE NEXT
TWO YEARS
Yes
No
ANSWER 6, 7, 8, AND 9 ONLY IF IMPORTED MATERIAL WILL BE RESHIPPED TO ANOTHER COUNTRY
6.
RESHIPMENT WILL BE BY
7.
UNDER THE FOLLOWING TYPE CUSTOMS ENTRY
Air
Water
Rail
Truck
IE
T & E
8. PORT OF EXIT FROM UNITED STATES
9. COUNTRY OF FINAL DESTINATION
10. NAME AND UNITED STATES ADDRESS OF APPLICANT
13. FORWARD THIS APPLICATION TO
(Please print and give street address, P.O. Box, if any, and ZIP code.)
U.S. Department of Agriculture, APHIS
Plant Protection and Quarantine
Permit Unit
4700 River Road, Unit 136
11. SIGNATURE OF APPLICANT
TELEPHONE NO. (Include Area Code)
Riverdale, Maryland 20737-1236