MDA Webforms | Sale-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.).

Applicant / Market Information

Prefix

Last Name *

First Name *

Middle Initial

Suffix

Business Name*

Address 1*

Address 2

City*

State*

County

Zip Code *

Ext. -

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

Confirm E-mail Address

Designate Applicant / Market Information as primary mailing address

Once the application is completed and signed, select Print below to create and save as a PDF. Please upload the saved PDF to Online Renewal Account or mail to the Missouri Department of Agriculture at PO Box 630, Jefferson City, MO 65102 with the annual license fee.

Market Owner Information

Last Name *

First Name *

Middle Initial

Business Name

Address 1*

Address 2

City*

State*

Zip Code *

Ext. -

Primary Phone*

* x

Phone Type * Ext.

E-mail Address

Confirm E-mail Address

Market Owner Information same as Applicant Information

Designate Market Owner Information as primary mailing address

Market Manager Information

Last Name *

First Name *

Middle Initial

Address 1*

Address 2

City*

State*

Zip Code *

Ext. -

Primary Phone*

* x

Phone Type * Ext.

E-mail Address

Confirm E-mail Address

Market Owner Information same as Applicant Information

Designate Market Manager Information as primary mailing address

Type of Animals Handled(Check All That Apply)

Cattle

Swine

Sheep

Goats

Equine

Poultry

Exotic Animals

Sale days & Times

Livestock

Day of Sale

-----OR-----

Single Day Sale

Frequency

--AND/OR--

Repeats

Time

AM and PM

Comment

Please Click Add Button For Each Sale Type.

Veternarian

Validate monthly report

Prefix

Last Name *

First Name *

Middle Initial

USDA Agreement Code*

State of Missouri License Number*

Please Click Add Button For Each Veternarian.

Business Home Office Information

select atleast one

Corporation

Patnership

COOP

PrivateOwnership

LLC

Bond Information

Bonding Institution*

Bonding Number*

Amount of bond*

Effective Date*

Satisfactory surety must be maintained at all times. This information is confidential and for office use only

Signature

By signing this application I acknowledge that I am aware of my responsibilities as outlined in 2 CSR 30-6.015 Requirements and Responsibilities of Market Licensee and 277 RSMo, 2000, Missouri Livestock Marketing 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.

Legal Name*

Date 04/24/2024

Market/Sale License Application

Sale days & Times