7003A Application for License (New License)

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reviewing the collection of information.
No license may be issued unless a completed application has been received (7 U.S.C. 2132-2143),
DO NOT USE THIS SPACE - OFFICIAL USE ONLY
and the applicant is in compliance with the standards and regulations Section 2133.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

SEND THE COMPLETED FORM TO:

APPLICATION FOR LICENSE
(TYPE OR PRINT)

LICENSE/CUSTOMER
NUMBER

EXPIRATION
DATE

AMOUNT

DATE RECEIVED

NEW LICENSE
1. NAME OF APPLICANT AND MAILING ADDRESS: (See Instructions)

2. ALL BUSINESS NAMES AND LOCATION ADDRESSES HOUSING ANIMALS:
INCLUDE DIRECTIONS TO EACH LOCATION (P.O. Box not acceptable)
Use additional sheet, if necessary

COUNTY:
TELEPHONE NUMBER:
3. IF THE APPLICANT IS A CORPORATION, PARTNERSHIP OR OTHER BUSINESS

COUNTY:
TELEPHONE NUMBER:
4. (A) PREVIOUS USDA LICENSE NUMBER: (If any)

ENTITY, LIST THE ENTITY’S PARTNERS OR OFFICERS AND AGENT FOR SERVICE
OF PROCESS.

NAME

(B) ACTIVE USDA LICENSE NUMBER IN WHICH YOU HAVE AN INTEREST:

TITLE

5. TYPE OF LICENSE:
Class A – Breeder

6. LIST YOUR 12 MONTH BUSINESS YEAR: (Calendar or Fiscal)
MO

FROM
DAY

YEAR

TO
DAY

MO

Class B – Dealer

Class C – Exhibitor

7. TYPE OF ORGANIZATION:
Individual

YEAR

Corporation

Partnership

Other __________________________________________________________
8. DEALERS ONLY - CLASS A OR CLASS B LICENSES MUST COMPLETE THIS
BLOCK. (Class C Licenses go to Block 9)

DOGS

NONHUMAN
PRIMATES

RODENTS
(Do not include
lab rats or mice)

ESTIMATE TOTAL NUMBER OF ANIMALS
TO BE PURCHASED IN THE NEXT
BUSINESS YEAR

CATS

MARINE
MAMMALS

WILD/EXOTIC
HOOFSTOCK

ESTIMATE TOTAL NUMBER OF ANIMALS
TO BE SOLD IN THE NEXT BUSINESS
YEAR

GUINEA PIGS

FARM ANIMALS

BEARS

WILD/EXOTIC
CANINES

WILD/EXOTIC
MAMMALS
(Not listed
elsewhere)

WILD/EXOTIC
FELINES

TOTAL
(All animals listed
in Block 9)

CLASS A (BREEDER) – LINE “D” = ½ OF LINE “C”
CLASS B (DEALER) – LINE “D” = LINE C LESS THE PURCHASE COST OF
THE ANIMALS SOLD. (9 CFR Sections 2.6 and 2.7)

A.

B.

C.

D.

9. EXHIBITORS ONLY - LIST THE LARGEST NUMBER OF ANIMALS THAT YOU HAVE HELD, OWNED,
LEASED, OR EXHIBITED AT ANY ONE TIME DURING THE PREVIOUS BUSINESS YEAR.
(9 CFR Sections 2.6 and 2.7)

ESTIMATE GROSS DOLLAR AMOUNT
DERIVED FROM REGULATED ACTIVITIES
(SALES, COMMISSIONS, ETC.)

$

HAMSTERS

ESTIMATE DOLLAR AMOUNT ON WHICH
FEE IS BASED

$

RABBITS

CERTIFICATION
I hereby make application for a license under the Animal Welfare Act 7 U.S.C. 2131 et seq. I certify that the information provided herein is true and correct to the best of my knowledge. I hereby
acknowledge receipt of and agree to comply with all the regulations and standards in 9 CFR, Subpart A, Parts 1, 2, and 3. I certify that the applicant is 18 years of age or older.

10. SIGNATURE:

APHIS FORM 7003A
AUG 2011

11. PRINT NAME AND TITLE:

(Previous editions are obsolete)

12. DATE: