Missouri Egg License Application

Please DO NOT include any personal, confidential, and/or sensitive information in your responses on this form (e.g. social security number, credit card information, health information, account number, etc.).

Application Type

selection required

Please select application type.*

New Application

Renew

License Type Information

choose at least one option

Retailer...(R1)...$5.00

Retailer...(R2)...Sells at farmers markets or roadside stands...$5.00

Dealer...(D1)...$5.00

Dealer...(D2)...$12.50

Dealer...(D3)...$25.00

Dealer...(D4)...$50.00

Processor...(P1)...$25.00

Processor...(P2)...$50.00

Processor...(P3)...$75.00

Processor...(P4)...$100.00

Total Due
$0.00

Owner Information

Prefix

required

Last Name *

First Name *

Middle Initial

Suffix

Business Name*

Address 1*

Address 2

City*

State*

County*

required

Zip Code *

Ext. - * x X

Primary Phone*

* x

Phone Type * Ext.

Alternate Phone 1

* x

Phone Type * Ext.

Alternate Phone 2

* x

Phone Type * Ext.

Alternate Phone 3

* x

Phone Type * Ext.

E-mail Address

* x

Confirm E-mail Address

x email and confirm email do not match

Missouri Tax ID #*

Owner Contact Option(s)

Check one or both* choose at least one option

Receive license, renewal and correspondence by mail

Receive license, renewal and correspondence by email

Store Location Information

Same Information as Above

Prefix

Last Name *

First Name *

Middle Initial

Suffix

Business Name*

Address 1*

Address 2

City*

State*

County*

* *

Zip Code *

Ext. - * x X

Primary Phone*

* x

Phone Type * Ext.

Alternate Phone 1

* x

Phone Type * Ext.

Alternate Phone 2

* x

Phone Type * Ext.

Alternate Phone 3

* x

Phone Type * Ext.

E-mail Address

* x

Confirm E-mail Address

x email and confirm email do not match

Upload No Tax-Due Statement

If you are applying for a Retailer (R1) Egg License, upload your no tax-due statement.
Without this statement, your egg license will be delayed until tax compliance can be confirmed.

Upload Name
JPEG , JPG , PDF

Signature

I certify this information is correct you must agree to the terms

Legal Name* legal name required

Date 04/23/2024

Confirmation Message

Are you sure you want to reset this form?
This will clear out all fields

Error Message

error icon

Missouri Egg License Application

If you are applying for a Retailer (R1) Egg License, upload your no tax-due statement. Without this statement, your egg license will be delayed until tax compliance can be confirmed.

If you are applying for a Retailer (R1) Egg License, upload your no tax-due statement.
Without this statement, your egg license will be delayed until tax compliance can be confirmed.