F&V License Application

APPLICATION FOR FRUIT AND VEGETABLE LICENSE
Purpose of application*

New LicenseRenewalCancel License
Name of Applicant*
Doing Business as
Business email*
example@example.com
Business phone*
Mailing address*
City, State*
Zip Code*
Phone
Check if physical address is same as mailing
Physical address
City, State
Zip Code
Phone
Name of individual in New Mexico that is authorized to receive legal notice*
Names of the agents selling for the above business in New Mexico*
Separate by commas
I'm applying for a*

Broker License (license fee $100 plus proof of $10,000 Bond)Dealer License (license fee $50 plus proof of $10,000 Bond)Packer & Shipper License (license fee $50 plus proof of $5,000 Bond)
Total due:
I would like to pay by*

CheckElectronic Payment
If you are a new business, please use "new" under *Invoice Number.
Please note that if we have not received a check within 30 days of you submitting an application, the application will be cancelled.
Fees should accompany your application and can be submitted by check or through electronic payment at nmdeptag.nmsu.edu. The bond and license must be approved prior to the shipping of any produce in the state of New Mexico.

Make checks payable to: NMDA Fruit and Vegetable Inspection Program
Mail to: New Mexico Department of Agriculture Fruit and Vegetable Inspection Program MSC 5600 PO Box 30005 Las Cruces, New Mexico 88003
If you have your bond please upload it below.

Cancelof

Please enter one commodity per line below. If you have more than the spaces here, please email f&v@nmda.nmsu.edu.
1. Enter commodity here.
2. Enter commodity here.
3. Enter commodity here.
4. Enter commodity here.
5. Enter commodity here.

I hereby make application for the above license(s) to engage in business in the State of New Mexico, and elect to be governed by the rules and regulations as stipulated by the Produce Marketing Act. I agree to abide by the provisions in this act requiring a complete and accurate set of records be kept of all transactions of fruits or vegetables received from any resident or grower in this state. I hereby agree to abide by all other provisions of the New Mexico Produce Marketing Act. This license shall be valid for one (1) year from the date that it is issued.
Signature of Applicant*

Clear
Should be Empty: