Online Licensing and Payment System

Company Legal Name (Registered Name):

DBA (If different):

Company Street Address (No PO Box):

Company Telephone:

Application for Structural Pest Control Company License

Company Information:

The data on this form will be used to process your application. Pursuant to MS Sec §297A.66, if your company maintains within the state an office or place of distribution or sales person or other employee that solicits, sells or delivers goods or services in the state you must have a Minnesota Tax ID number.

Does your company maintain within the state an office or place of distribution or sales person or other employee that solicits, sells or delivers goods or services in the state?
If yes, enter MN Tax ID number in the space provided below.

You must provide your Minnesota Tax ID number. If you do not have one, you must provide your social security number (MS Sec §270C.72 ). We are required by law to collect this information and we cannot grant your license without it. No one will have access to your social security number except those permitted access by law, your written consent, court order, or those department employees whose job duties require access.

If you are unsure if you need a Minnesota Tax ID, contact the Minnesota Department of Revenue at www.revenue.state.mn.us.

Minnesota Tax ID or if none, Social Security Number:

Company Mailing Address: (Fill this section if Company physical address listed above is different from Company mailing address)

Company Name:

Company Mailing Address:

City: State: Zip Code: