ARM-ACM-437 (Rev. 8/10)
Wisconsin Dept. of Agriculture, Trade and Consumer Protection
Division of Agricultural Resource Management
Bureau of Agrichemical Management
Phone: (608) 224-4616
FOR DATCP USE ONLY
100 7120 P7 731R 8250 09 |
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Feed Export Certificate of Free Sale Application
s. 93.06(1)(f), Wis. Stats.
LEGAL BUSINESS NAME AND ADDRESS |
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MAILING ADDRESS (IF DIFFERENT FROM LEGAL ADDRESS) |
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LEGAL BUSINESS NAME |
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BUSINESS NAME |
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CONTACT NAME |
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CONTACT NAME |
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STREET ADDRESS |
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PO BOX |
STREET ADDRESS |
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PO BOX |
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CITY |
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STATE |
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ZIP |
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ZIP |
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DOING BUSINESS AS NAME |
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FEED LICENSE NUMBER |
EXPIRATION DATE OF LICENSE |
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CERTIFICATE REQUIREMENTS:
1. To obtain a certificate the company must be a current holder of a Wisconsin Commercial Feed License.
2. If product is being exported to more than one country, an additional certificate will be required for each country. 3. Product must be manufactured in Wisconsin.
NOTE: Requestor must know export/import requirements and regulations of individual country(s).
WISCONSIN SITE INFORMATION: Wisconsin licensed manufacturing/labeling/distributing street address to be listed on certificate of free sale:
WISCONSIN MANUFACTURING/LABELING/DISTRIBUTING STREET ADDRESS |
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NAME OF PRODUCT(S) AS THEY ARE TO APPEAR ON CERTIFICATE |
(SUBMIT LABELS) |
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EXPORT ASSISTANCE
The Wisconsin International Trade Team at the Wisconsin Department of Agriculture, Trade and Consumer Protection provides a broad array of services to help Wisconsin companies succeed in their exporting efforts. The Wisconsin International Trade Team is a collaboration of the Wisconsin Department of Commerce and the Department of Agriculture, Trade and Consumer Protection. Contact the Wisconsin International Trade Team at: 1 (800) 462-5237, email at international@wisconsin.gov, or visit http://www.datcp.state.wi.us/mktg/business/marketing/international/index.jsp.
FEE
A.WDATCP (make check payable to Wisconsin Department of Agriculture, Trade and Consumer Protection): For EACH health certificate requested: $15.00...........................................................................................................
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X $15.00 = |
All certificates are returned to the exporter using First Class mail by the USPS unless the exporter provides an alternative means (shipping labels, shipping envelopes, and charge account numbers must be provided by the exporter).
Certificates may need to be sent to Secretary of State depending on the country to which products are being exported. The department does not automatically forward requests to Secretary of State. For their form, contact Secretary of State at (608) 266-5503, http://www.sos.state.wi.us/apostilles.htm, or Secretary of State, Certification Desk, 30 W Mifflin St, 10th Floor, Madison, WI 53703.
I certify that all information on this application is true and correct.
APPLICANT SIGNATURE
YOUR NAME AND TITLE (PRINT OR TYPE)
Personal information you provide may be used for purposes other than that for which it was originally collected (S. 15.04(1)(m) Wis. Stats.).
Make check payable to: Wisconsin Department of Agriculture, Trade and Consumer Protection (WDATCP)
Mail form and check to: State of Wisconsin, DATCP, Box 93193, Milwaukee WI 53293-0193
Allow ten (10) working days for the processing of your request.
