Your address must contain all the information listed below. |
Name: | |
Telephone: | |
DBA (Doing Business As, or Business Name): | |
Address: | |
City: | |
State: | |
Zip: | |
County: | |
Region: (See organization map at http://www.aphis.usda.gov/ac/acorg.html to determine which region handles your state.) | (Please check one)
______Eastern Region
______Western Region |
|
What species of animal(s) do you own or will you be using? | |
What type of activity are you intending to do with the animals? (such as breeder, dealer, exhibitor, research, transportation handler, or transportation carrier) | |
Are you, or will you be, a traveling exhibitor? Yes or No | |
Do you have a previous Certificate Number? If so, please include the number in this request. | |