Registration form for arborist or pesticide application business

Note the following items as you start the online application;

• Complete all sections of the application including pertinent employer/business information
• Fee amounts due will be calculated at the end of the application process.
• Payment must be made by credit or debit card or electronic check draft.
• Fees are non-refundable and non-transferrable.
• You will be notified by email once your application has been processed successfully.

If you have any questions regarding the online renewal application process, visit the DEEP Pesticide Management Program webpage for additional information.

If you are ready to proceed, then please complete the following question(s) as directed.

To continue, select "Next" below

Select "Close and Save" if you wish to return at a later time
Address Information 1. Review and update the applicant's physical location address:

Contact Information 3. Enter the applicant's phone #: (959) 929-8292
4. Enter the applicant's cell phone: (959) 929-8292
5. Enter the applicant's email address: aaron.davis53@aol.com

Personal Information 6. Enter the Applicant's Date of Birth: 01/23/2000
7. Enter the Applicant's Social Security Number: **********
Exemption (CS) 8. Are you requesting the Arborist Certification Category? No
9. By selecting "Yes" I attest to fee exemption based on employment as a federal, state or municipal employee for which this certification is required for employment.

NOTE: Any government certified applicator is not authorized to perform pesticide services for a non-government commercial business. To claim government exemption you must ONLY perform pesticide duties as part of your government employment.
Any government exempt applicator executing commercial pesticide work can be charged with financial penalties and revocation of their certification. Yes

Employer Business Address 10. Add or update your Employment Business Address:

Attestation Individual 13. Enter the Full Name of the Applicant attesting: aaron j davis
14. By selecting Yes, I attest that I have personally examined and am familiar with the information submitted in this document and all attachments thereto, and I certify that based on reasonable investigation, including my inquiry of those individuals responsible for obtaining the information, the submitted information is true, accurate and completed to the best of my knowledge and belief. I understand that a false statement in the submitted information may be punishable as a criminal offense, in accordance with section 22a-6 of the General Statutes, pursuant to section 53a-157b of the General Statutes, and in accordance with any other applicable statute.
I understand that future official correspondence, including renewal notices will be sent by e-mail to the e-mail address provided on page one of this application and that I am responsible to notify DEEP of changes to the information contained in this application within thirty (30) days.
I also understand that I must complete the examination process within 90 days of DEEP receiving this application, otherwise this application will be denied and any fees paid will not be refunded. Yes

Review Instructions YOU ARE ALMOST DONE WITH YOUR ONLINE APPLICATION

To complete the process, select "Next" below to proceed to the Review screen where you are able to see all responses on this application.

Then next select "Add to Invoice" where you will be able pay your fees due, or select "Finish" if you have no fees due.

Once your payment has been accepted you will be notified via email that your application has been processed.