MDA Webforms | Egg-License-Form

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.).

License Type Information Selection Required *

Retailer...(R1)-Farmer's Markets/Roadside Stands Only...$25.00
Retailer...(R2)...$25.00
Dealer...(D1) ...$40.00
Dealer...(D4)...$50.00
Processor...(P1)...$60.00
Processor...(P3)...$75.00
Processor...(P4)...$100.00

Total Due
$

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

Owner Information

Prefix

Last Name *

First Name *

Middle Initial

Suffix

Business Name *

Address 1 *

Address 2

City *

State *

County *

Zip Code *

zip plus four -

Primary Phone *

Phone Type Ext.

E-mail Address

Confirm E-mail Address

Missouri Tax ID #

Owner Contact Option(s) Selection Required

Check one or both*

Receive license, renewal and correspondence by mail
Receive license, renewal and correspondence by email

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 *

zip plus four -

Primary Phone *

Phone Type Ext.

E-mail Address

Confirm E-mail Address

Upload No Tax-Due Statement

If you are applying for a Retailer Egg License you must upload your no tax-due statement.
Without this statement, your egg license will not be issued.

If you only sell at Farmer’s Markets or Roadside Stands, and do not make annual sales of
$25,000 or more from the sale of “farm products” check this box to be exempt from
supplying the no tax-due statement.

Upload Name
JPEG , JPG , PDF

Number of uploads

Signature

I certify this information is correct Required

Legal Name*

Date 04/08/2026

Missouri Egg License Application