Missouri Department of Agriculture

ACFA License/Registration Application

Application Type
Facility Information
Facility Name*
Address 1*
Address 2
City* State*
Zip code*
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County*
Primary Phone*
Phone 1
Phone 2
Phone 3
Owner Information/Authorized Representatives
*
*
 
*
*
*
 
*
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Authorized Representatives
Type of License*
Has your facility gone out of business?*
CEU Credits Period Covered
Do you have a license by USDA-REAC?*
Do you operate or have an interest in, financial or otherwise, any business operation or facility involving dogs & cats at any other locations?*

Operation Involves*

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Please attach any additional documentation (CEU credits, proof of show, non-profit certification, or any other image) here

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