Pesticide Dealer License

Application for New Mexico Pesticide Dealer License
Business Name*
Responsible Individual*

First NameLast Name
Title*
Business Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Physical Address (if different than mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone No.*
E-mail*
example@example.com
A separate license is required for each location in New Mexico, or for the principal out-of-state location if there are no locations in New Mexico.

Once the form is received by NMDA, an invoice will be issued to the email address listed on the form.
READ BEFORE SIGNING
Each applicant for a pesticide dealer license for outlets within New Mexico shall provide adequate facilities for the storage and distribution of restricted use pesticides.

It is a violation of the Pesticide Control Act for a Dealer to sell any restricted-use pesticide to someone who is not licensed.

Dealers must keep records of all State or Federal restricted-use pesticide sales. Records must include the name and license number of the certified applicator purchasing the pesticide, date of sale, brand name of the pesticide, EPA Registration Number, and quantity of the pesticide.

Each pesticide dealer shall be responsible for the acts of each individual employed by him in the solicitation and sale of pesticides and all claims and recommendations for the use of pesticides.

A Dealer license does NOT cover offering or supplying technical advice; supervising or assisting with the use of a pesticide; or making pesticide recommendations.

My signature affirms that the information provided here is true and correct to the best of my knowledge.
Responsible Individual's Signature*
DateTime*
nmdeptag.nmsu.edu | (575) 646-2134 | pesticides@nmda.nmsu.edu
Should be Empty:

Application for New Mexico Pesticide Dealer License

READ BEFORE SIGNING