Warehouse Regulations Under the United States Warehouse Act

Instructions For WA-53

Instructions For WA-53
APPLICATION FOR A LICENSE TO INSPECT, CLASSIFY, SAMPLE AND/OR
WEIGH COMMODITIES UNDER THE UNITED STATES WAREHOUSE ACT
Applicants for personal licensing under the United States Warehouse Act to inspect, weigh,
classify as to condition, grade, and class, and/or sample agricultural products within the authority
of an existing United States Warehouse Act license use this form.
Submit the original of the completed form in hard copy or facsimile to the Kansas City
Commodity Office (KCCO), Warehouse License and Examination Division, STOP 9148, P.O. Box
419205, Kansas City, MO 64141-6205; or FAX 816-926-1774. Customers who have established
electronic access credentials with KCCO may electronically transmit this form to KCCO. Features
for transmitting the form electronically are available to those customers with access credentials
only. If you would like to establish online access credentials with KCCO, follow the instructions
provided at the USDA eForms web site.

Applicants must complete Items 1 through 14. The warehouse operator
completes the certification in Item 15. FSA completes the certifications in
items 16 and 17.
Items 16 and 17 are for FSA use only.

Fld Name/

Instruction

Item No.
A

Enter the name of applicant.

Name of Applicant
B

Enter USWA license number.

USWA License No.
C

Enter fee.

Fee

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Instructions For WA-53

Items 1 through 14

Instruction
Fld Name/
Item No.
1

Check the box indicating the services the applicant intends to provide.

Type of Service
License Requested

With a License to: Applicant will be Certifying:
Inspect and Weigh Condition and Weight
Inspect, Classify, and Weigh Condition, Class, Grade,
and/or Weight
Weigh Weight
Classify Condition, Class, and/or Grade
Sample (No Certification)
Sample, Classify and Weigh Condition, Class, and/or Weight
Sample and Weigh Weight
According to ' 7CFR735.200

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Instructions For WA-53

Check the box indicating the type of warehouse(s) at which the applicant
will be providing the service requested in Item 1.
2
Type of Warehouse
3

Check the box indicating the certification the applicant intends to give.

Type of
Certification

See the table in Item 1.

4

Check the box indicating whether the applicant needs facsimile or Esignature authority.

Facsimile or ESignature
Enter the name of the warehouse and the city and state location in which
the service will be performed.

5
Name and address
of Warehouse in
which the
applicant will
performs the
service

Enter the complete mailing address of the warehouse in which the service
will be performed. (So that we may mail the license to the applicant.)

6
Location of
Warehouse

Instruction
Fld Name/
Item No.

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Instructions For WA-53

7
Name and Address
of Present
Employer
8

Enter the name and address (city, state) of the licensed warehouse
operator for whom the applicant will be performing the activities
requested for licensing.

Enter the month and year employed by this warehouse operator.

Date Employed
9

Enter present duties or the applicant’s job title with the current employer.

Present Duties or
Title
10
State the
applicant’s

Enter a summary of the applicant’s past experience with inspecting,
grading, sampling, classing and/or weighing of agricultural products
covered by this application including the number of years at a specific
employer= s warehouse.

experience
(etc.)
11
Is the applicant
presently licensed
(or has the
applicant ever been
licensed)?
12

Check the box indicating whether the applicant has ever held a USWA
license. Enter any license number, dates of license, and the name of the
employer for whom the applicant may have held a USWA license for a
similar service.

Enter training course work completed including grain grading schools,
seminars and the like along with dates of attendance.

Please indicate any
special training
(etc.)

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Instructions For WA-53

13 A - D

13 A. Enter the names of four persons who know the applicant’s

Give names and
addresses (etc.)

recent qualifications for the service(s) under application.
The applicant’s most recent previous employer should be
on this list. All others should not be the applicant’s
immediate family or warehouses the applicant will service.
13 B. Enter the address of four persons who know the applicant’s
qualifications for the service(s) under
application.
13 C. Enter the telephone number of four persons who know the
applicant’s qualifications for the service(s) under
application.
13 D. Enter the occupation of four persons who know the
applicant’s qualifications for the service(s) under
application.
14 A. Enter the applicant’s signature as the applicant wishes the license to
be issued.

14 A-C
14 B. Enter the date of the signature.
Applicant= s
Certification

14 C. Enter the applicant’s LEGIBLY printed name as the
applicant wishes it to appear on the license.

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Instructions For WA-53

15 A. Warehouse operator enters name of warehouse operator:
15 A-D

Enter the warehouse operator= s full legal name and type of organization:

Warehouse
Operator= s
Certification

For a proprietor, enter, for example A Susan Doe@ .
For a corporation, enter, for example, A Does, Inc.@ , A a BLANK
corporation@ , where BLANK is the name of the state of incorporation.
For a general partnership, enter, for example A Letitia Doe, Frank Doe,
Selma Doe, and James Doe, copartners, trading as Doe Farms@ then A
under the laws of BLANK@ where BLANK is the state under whose
laws the partnership is organized.
For a limited partnership, enter, for example A Doe Farms Limited
Partnership under the laws of BLANK, Selma Doe, General Partner@
where BLANK is the state of organization and under whose laws the
applicant operate.
For a limited liability company, enter, for example A Doe Farms, L. L.
C., a BLANK limited liability company@ where BLANK is the name of
the state under which organized).
15 B. Enter the authorized signature.
15 C. Enter the signer= s title.
15 D. Enter the date signed.

Items 16 and 17 are for FSA use only.

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