North Dakota Department of Agriculture

Fertilizer Distributors - New License Application

Enter the following information about the North Dakota Fertilizer Distributor License Applicant:

Company Name: *
Contact Name:

Street Address
Address 1: *
Address 2:
City: * State: * Zip: * -

Mailing Address         Same as Street Address
Address 1:
Address 2:
City: State: Zip: -

Miscellaneous Company Information
Phone: *
Fax:
Email address: *
County:

Fertilizer Distributor Information
Does this location Manufacturer Fertilizer?:
Does this location Blend Fertilizer?:
Does this location Sell Dry Fertilizer?:
Does this location Sell Liquid Fertilizer?:
Does this location Sell Anhydrous Ammonia?:
Does this location Sell Soil Amendments?:
Does this location Sell Plant Amendments?:
Does this location Sell/Distribute to End Users?: