ARIZONA DEPARTMENT OF AGRICULTURE FOR ADA USE ONLY

Citrus, Fruit and Vegetable Division Check #:____________________

Mail: 1802 W Jackson St, #78 Phoenix, AZ 85007 Check Date__________________
1110 W Washington St Ste #450 Phoenix, AZ 85007 Amount:$____________________
(602) 542-0944 Fax: (602) 542-0898 Line #: ______________________
New License #:_______________

CITRUS FRUIT STANDARDIZATION

CITRUS DEALER LICENSE APPLICATION

Applicant Name: _________________________________________________

Email Address:
(Required)

Company Name: _________________________________________________________________________________

Tax ID / Social Security Number: Contact Name: _____________________________

Mailing Address: _________________________________________ City ______________________St __ Zip______

Physical Address: ________________________________________ City ______________________St __ Zip______

Telephone: _________________________ Cell: ___________________________________

Name of statutory agent in this state for service of legal notice:____________________________________________________________

Applicant is: Individual Partnership Firm Corporation Association Trust or Cooperative

Full name of each member of the partnership or firm: Full name of each officer, director or trustee:

If the applicant acts as a commission merchant, a schedule of commissions and charges for services must be provided, which may
not be altered during the term of the license except by written agreement between the parties involved.

Pursuant to Arizona Revised Statutes (A.R.S. 3-449), it is unlawful to transact business as a citrus fruit dealer or shipper without first
obtaining a license from the Department. The Department is required by law to process this application within 28 days. Fee must
accompany this application. DO NOT SEND CASH! INCOMPLETE APPLICATIONS OR APPLICATIONS WITH INCORRECT FUNDS WILL
BE RETURNED. Each license issued shall be valid for a period of one year, or portion thereof, and shall expire on September 1st.
Applications received after September 15th shall pay a penalty of $25.00. Applications received after October 1st shall pay a penalty of
$50.00

In compliance with Title 3, Chapter 3, Article 2, Sections 3-449 of the Arizona Revised Statutes license fees are based on gross sales
from the previous season.
PLEASE CIRCLE ONE OF THE BELOW
License Fee $150.00 - Gross Sales of $200,000 or less.
License Fee $300.00 - Gross Sales between $200,000 and $500,000.
License Fee $450.00 - Gross Sales of $500,000 or more.
By signing below, pursuant to Arizona Revised Statutes (A.R.S.) 3-449, the applicant acknowledges under penalty of perjury that the
applicant has had no license to handle citrus, fruit or vegetables denied, suspended or revoked in any state; and that the applicant is
of sound financial condition and that there are no outstanding judgments at the time of this application.

Applicant Signature:_______________________________________________________________________Date:_____________________