PESTICIDE PRODUCT REGISTRATION

PESTICIDE PRODUCT REGISTRATION
Application is made to register the following pesticides as provided for in Chapter 76, Article 4, Sections 1 through 39, New Mexico Statutes Annotated 1978 Compilation and regulations adopted by the Board of Regents, New Mexico State University.
For year ending December 31,*
ALSTAR member?*

YesNo
Please provide your Temporary Product ID*
Example: XXXX000257
Please attach an image of your label and the Notice of Supplemental Distribution, if applicable.*

Cancelof
New company?*

YesNo
Please provide your Current Company ID:*
Example: 0003XS
Registrant*
Registrant's Mailing Address*
City
State
Zip Code
Submitted By
Name of Business if different than Registrant.
Mailing Adddress
City
State
Zip Code
Form filled out by
Name and Title
Date

MonthDayYear
Date
Telephone
E-mail*
A copy of this application will be sent to this email.
Would you like the invoice to be sent to the above e-mail?*

YesNo
Invoice E-mail*
Please enter the best e-mail to send an invoice to.

Please enter all information for each product.*

	Classification	Product Name	New Active Ingredient?	EPA Registration Number (or 25(b) or Device if applicable)
Product 1
Product 2
Product 3
Product 4
Product 5
Product 6
Product 7
Product 8
Product 9
Product 10