Form EPA Form 8570-5 EPA Form 8570-5 Notice of Supplemental Distribution of a Registered Pest

Please Read All Instructions before Completing this Form (Form must be typed)

Form Approved. OMB No. 2070-0044

United States

ENVIRONMENTAL PROTECTION AGENCY
Office of Pesticide Programs (Mail Code: 7504P)

Washington, DC 20460

Notice of Supplemental Distribution of a Registered Pesticide Product
Instructions
Registrants may distribute or sell the products under another company’s name and address instead of (or in addition to) their own
after obtaining final registration. Such distribution and sale is termed “supplemental distribution” and the product is referred to as a
“supplemental registration” or “distributor product.” The distributor, also known as a “sub registrant,” is considered an agent of the
registrant. Both the registrant and the distributor may be held liable for violations pertaining to the distributor product.
A Notice of Supplemental Distribution of a Registered Pesticide Product must be submitted by the basic registrant for each
distributor product. The basic registration number and the distributor company number must be shown. If a potential distributor
does not have a company number assigned, the registrant should have the distributor request one from the Registration Division
prior to submitting this form to the agency. The request should be written on the distributor company’s letterhead and sent to the
address above. The completed form must have the concurrence and signature of both the registrant and the distributor.
EPA Registration Number of Product
Distributor Company Number

Note: Do not submit distributor product labels
Name of Registered Product (basic, EPA-accepted product name)

Distributor Product Name

Name and Address of Distributor (Type; include ZIP code)

Read All Conditions Before Signing
1. The distributor product must have the same composition as the basic product.
2. The distributor product must be manufactured and packaged by the same person who manufactures and packages the registered
basic product.
3. The labeling for the distributor product must bear the information as that of the registered product. Specific claims may be
omitted from the distributor’s label provided that no other changes are necessary.
4. The product must remain in the manufacturer's unbroken container.
5. The label must bear the EPA registration number of the basic product, followed by a hyphen and the distributor's company
number.
6. Distributor product labels must bear the name and address of the distributor qualified by such terms as "packed for ...”,
"distributed by ... ", or "sold by ..." to show that the name is not that of the manufacturer.
7. All conditions of the basic registration apply equally to distributor products. It is the responsibility of the basic registrant to see
that all distributor labeling is kept in compliance with requirements placed on the basic product.
Distributor
We intent to market our product under the Distributor Product Name specified above, subject to the conditions specified in this Notice.
Signature end Title of Distributor

Date

________________________________________________________________

___________________________

Registrant
I agree that the distributor named above may distribute and sell the Distributor Product specified above, subject to the conditions specified
in this Notice.
Signature end Title of Registrant

Date

________________________________________________________________

___________________________

EPA Form 8570-5 (Rev. 2-13) Previous editions are obsolete.

PAPERWORK REDUCTION ACT NOTICE
The average estimated burden to report information for this collection is 19 minutes per
response. Burden estimates include time for reading the instructions, gathering information,
completing and submitting the necessary forms. An Agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently
valid OMB control number. Send any comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to:
Director, Collection Strategies Division, U.S. Environmental Protection Agency (Mail Code:
2822), 1200 Pennsylvania Avenue, N.W., Washington, DC 20460; and to: Office of
Management and Budget, Paperwork Reduction Act Project (2070-0044), Washington, DC
20503, marked “Attention: Desk Officer for EPA.” Do not send this form to the addresses in this
notice.