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
Format: (000) 000-0000.
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.*

Rows	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