MDA Webforms | Egg-License-Form

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Application Type

selection required

Please select application type. * New Application

This form is for NEW egg license applications only. For renewal of a current license, please complete the Egg License Renewal Application.

License Type Information Selection Required *

choose at least one option

Retailer Egg License: $25.00
Dealer Egg License D1 (0-100 cases sold in the shell per week): $40.00
Dealer Egg License D4 (101+ cases sold in the shell per week): $50.00
Processor Egg License P1 (0-250 cases processed per day) : $60.00
Processor Egg License P3 (251-1,000 cases processed per day): $75.00
Processor Egg License P4 (1,001+ cases processed per day): $100.00

Total Due
$

The 2027 license year begins on July 1, 2026,
and expires June 30, 2027.

Owner Information

Prefix

required

Last Name *

last name required

First Name *

first name required

Middle Initial

Suffix

Selection Required

Business Name *

Business Name is missing

Address 1 *

Address Line 1 is required

Address 2

City *

City is required

State *

Selection Required

County *

required County is required

Zip Code *

zip plus four - zip code required zip code invalid zip code extension invalid

Primary Phone *

phone required phone invalid

Phone Type Selection Required Ext.

E-mail Address

Email is required Invalid email format found

Confirm E-mail Address

email and confirm email do not match email and confirm email do not match

Owner Contact Option(s)

Check one or both * Selection Required Receive license, renewal and correspondence by mail
Receive license, renewal and correspondence by email choose at least one option

Location Information

Same Information as Above

Prefix

Selection Required

Last Name *

last name required

First Name *

first name required

Middle Initial

Suffix

Selection Required

Business Name *

store location business name required

Address 1 *

store location address 1 required

Address 2

City *

store location city required

State *

Selection Required

County *

Selection Required *

Zip Code *

zip plus four - zip code required zip code invalid zip code extension invalid

Primary Phone *

phone required phone invalid

Phone Type Selection Required Ext.

E-mail Address

Email Required Email Invalid

Confirm E-mail Address

Email and confirm email do not match

Tax Obligation Attestation

I hereby certify under penalty of perjury that I am current with and compliant in all Missouri sales, use, and withholding tax obligations, and that I owe no delinquent taxes as required under RSMo Section 144.083.

Tax obligations attestation checkbox is required.

Signature

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

Legal Name*
legal name required

Date 10/03/2026

Confirmation Message

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Error Message

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Missouri Egg License Application