ST-1 Application for Service

SCIENCE & TECHNOLOGY PROGRAM
APPLICATION FOR SERVICE
SERVICE REQUESTED FROM DIVISION/BRANCH

IN ACCORDACE WITH THE APPLICABLE PROVISIONS OF THE REGULATIONS ISSUED BY THE AGRICULTURAL MARKETING SERVICE, U.S. DEPARTMENT OF AGRICULTURE,
APPLICATION IS HEREBY MADE FOR THE FURNISHING OF SERVICE(S) CHECKED BELOW:

LABORATORY CHEMICAL AND BIOLOGICAL TESTING SERVICES BY THE NATIONAL SCIENCE LABORATORIES (NSL)
LABORATORY APPROVAL PROGRAM(S) BY THE LABORATORY APPROVAL SERVICE (LAS)
SEED TESTING SERVICES BY THE SEED REGULATORY AND TESTING DIVISION (SRTD)
INTELLECTUAL PROPERTY PROTECTION OF NEW PLANT VARIETIES BY THE PLANT VARIETY PROTECTION OFFICE (PVPO)
APPLICATION TYPE
REVISION

NEW
APPLICANT INFORMATION
BUSINESS NAME
(INCLUDE DBA AS, WHERE APPLICABLE)
TAX ID NUMBER
BILLING ADDRESS
PHYSICAL ADDRESS

APPLICANT CONTACT INFORMATION
PRIMARY

BILLING

NAME

NAME

TITLE

TITLE

PHONE

PHONE

EMAIL

EMAIL

EMAIL

EMAIL

PRINT NAME

SIGNATURE

DATE

SUBMIT COMPLETED FORM TO:
EMAIL

[email protected]

PHONE

704-867-3873

FAX

855-296-1230

MAILING ADDRESS

USDA, AMS, S&T, 801 SUMMIT CROSSING PL, GASTONIA, NC 28054

FOR OFFICIAL USE ONLY
RECEIVED BY

RECEIVED (DATE)

PROCESSED BY

PROCESSED (DATE)

PVND REQUEST NO.

UNIQUE RECORD ID (ZURI)

CUSTOMER NO.

CUSTOMER TYPE

According to the Paperwork Reduction Act of 1995, an agency may not conduct, or sponsor and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid
OMB control number for this information collection is 0581-0251. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information.
U.S. Department of Agriculture Non-Discrimination Statement: https://www.usda.gov/non-discrimination-statement

OMB CONTROL NO. 0581-0251
Ver. 6/2023

FORM ST-1 (REPRODUCE LOCALLY)