MDA Webforms | Livestock-Dealer-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.).

Applicant 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.

Alternate Phone 1

Phone Type Ext.

Alternate Phone 2

Phone Type Ext.

Alternate Phone 3

Phone Type Ext.

E-mail Address

Confirm E-mail Address

Business Information (Check All That Apply)

Type of Livestock (Choose at least one) * Selection Required CattleSwineEquineExotic AnimalsSheepGoatsPoultryCervidae

select atleast one type of livestock

Trade Area * Selection Required IntraState
InterState

select at least one trade area

Agent Information

At least one agent must be added for a valid submission.

Last Name *

First Name *

Middle Initial

Address 1 *

Address 2

City *

State *

Zip Code *

zip plus four -

Primary Phone *

Phone Type Ext.

E-mail Address

Confirm E-mail Address

At least one agent must be added.

Bond Information

Bonded by packers and stockyards *

YesNo

Bond Number *

Signature

By signing this application I acknowledge that I am aware of my responsibilities as outlined in 2 CSR 30-7.010 Provisions for Registration and Recordkeeping of Livestock Dealers and 276.600 – 276.661, RSMo, 2000, Missouri Livestock Dealer Law, and further agree to comply with all animal health laws and regulations pertaining to the movement of animals, animal well-being and procedures used for the control of disease. Required

Legal Name*

Date 04/10/2026

Livestock Dealer Application