5b. Does the business have additional trade names? Yes No

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

APPLICATION FOR LICENSE

(Under the Perishable Agricultural Commodities Act, 1930)

OMB Approved - 0581-0031

The information requested on this form is required under the Perishable Agricultural Commodities Act (7 CFR 46.4) for the issuance of a license. The information contained in this form will be used by Federal, State,

local, or foreign agencies when relevant to civil, criminal, or regulatory investigations or procedures. Failure to provide the information required will result in delay or suspension of the processing of this form.

ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE RETURNED. 

1a. Name of Business (Full Legal Name of Business registered under EIN) 1b. If Sole Proprietor, enter Owners Full Name

2. Federal Employer Identification Number (EIN) 3. Web Site

4a. Physical Business Address (Post Office Box NOT ACCEPTABLE)

Street Address

City State Zip Code+4

Primary Number (With Area Code) Fax Number (With Area Code) Primary E-Mail Address

Secondary Number (With Area Code) Fax Number (With Area Code) Secondary E-Mail Address 

4b. Mailing Address (Mark an “X” here if same as Business Address):

Street Address (Post Office Box Number) Attention:

City State Zip Code+4

5a. Does the business have any branch locations other than your physical business address? How many?

 5c. Please list Trade Names and/or Branch Locations Below. (Attach a separate page for additional entries)

FTPP-211 (02-18)

Page 1 of 4 

Trade Name City State

State Date of Incorporation/Organization

Month Day Year

6a. Legal Structure (see page 4 for explanations)

(CHECK ONE BOX ONLY)

6b. Complete only if you checked Corporation or LLC

Sole Proprietor

Limited Liability Company (LLC) (see 6b and 6c)

Partnership 

Limited Partnership

Limited Liability Partnership (LLP)

Association

Trust

Estate

6c. Complete only if you checked LLC. These items MUST be submitted with 

application. 

Articles of Organization is included with application

Operating Agreement is included with application

8. Primary Nature of Business: (see page 4 for explanations)

(CHECK ONE BOX ONLY)

7. Types of Fruits and Vegetables Handled by Applicant

(CHECK ONE BOX ONLY)

For questions call (800) 495-7222 ext 1 

or email: PACALicense@ams.usda.gov

PACA Website:

http://www.ams.usda.gov/paca
FTPP-211 (02-18)

Page 2 of 4

9. List below the required information for Individual Owner; All Partners; All Members and/or Managers of LLCs; All

Officers (Including Titles), Directors, and/or Stockholders holding more than 10 percent of outstanding voting

stock. If any person listed is a minor, furnish the name of His/Her guardian. If any person listed is a trust, furnish

the name of the trustee. If any person listed is an estate, furnish the name of the Executor/Executrix.

*******The amount of stock held should total 100%. 

(Attach a separate page for additional entries)

Name

Last Name (Print on First Line)

First Name and Middle Initial

 EIN #

For legal 

entities

Home Address

First Line - Number and Street

Second Line - City, State, and ZIP Code

(Post Office Box NOT ACCEPTABLE)

Title

(Including 

Director)

Percentage

of Stock or 

Ownership

Smith 123 Main Street President 75% 

John A. Anytown, DC 12345-7890

10. Has the applicant or any person listed in Question 9 filed bankruptcy, been discharged as a bankrupt, or been an

officer, director, shareholder, partner, member/manager (LLC), or owner of a firm that has filed bankruptcy or been

discharged as bankrupt?

Yes No If Yes, identify the firm or individual (PACA license number, if possible), the name and

address of the firm involved, and details about bankruptcy. Submit a copy of the bankruptcy

petition, schedules, disclosure statements, and all other relevant documentation. (Attach a 

separate sheet for additional space)

11. Has any person listed in Question 9 been convicted of a felony in any State or Federal Court?

Yes No If Yes, furnish the name, date of birth, and alias (if any), of the individual(s). FOR ALL

CONVICTIONS, provide the name and location of the court, date convicted, nature of the

felony, sentence imposed, where served; if paroled, give date terminated or will terminate.

(Attach a separate sheet for additional space)

12. Has any person currently employed by the applicant been the individual owner, partner, officer, director, or holder

of more than 10 percent of the outstanding voting stock of a firm, association, or corporation, or a member/

manager (LLC) whose PACA license is under suspension; been revoked; found to have committed any flagrant or

repeated violation of the PACA, or against which there is an outstanding unpaid reparation award?

Yes No If Yes, furnish the full name of the person, name of the firm involved (PACA License number

if possible), and details of such connection, including the dates thereof. (Attach a separate

sheet for additional space)
FTPP-211 (02-18)

Page 3 of 4

13. Is the applicant currently operating at volumes requiring a PACA License? (See Page 4 for Nature of

Business)

Yes No If Yes, provide the date applicant first met that volume.

Month Day Year

SCHEDULE A Applicants - Wholesalers, Brokers, Commission Merchants, Food Service, Growers, Grower’s

Agent, Processors, and Shippers

(A1) Current License Fees

Annual License Fee $ 995.00

Branch Fee, if applicable: $600.00 X branches (maximum of $7,005) $ 

TOTAL AMOUNT DUE FOR CURRENT FEES (A1) $ 

(A2) Accrued fees for previous operations based on the date provided in question 13. (Maximum of 24 months)

October 1, 2010 to Present

Annual License Fee = $82.92 per month X months $ 

Annual Branch Fee = $50.00 per month X months X branches $

TOTAL AMOUNT DUE FOR PREVIOUS OPERATIONS (A2) $ 

TOTAL AMOUNT DUE FOR CURRENT (A1) & PREVIOUS OPERATIONS (A2) $ 

SCHEDULE B Applicants - Retailers and Grocery Wholesalers ONLY (all others use Schedule A)

TOTAL AMOUNT DUE $100

PAYMENT 

TOTAL AMOUNT DUE $

CHECKS: Make payable to USDA - PACA

CREDIT CARDS: Type of Card:

VISA

MASTERCARD

DISCOVER

AMERICAN EXPRESS

Account Number:

Exp. Date: Mo: Year

Card Holder’s Name:

If Paying Fees by Credit Card, completed

application can be faxed to (202) 260-8575

Application must be signed by the Owner, all Partners, all

General Partners, Member/Manager (LLC) or a Corporate

Officer.

CERTIFICATIONSTATEMENT

I (We) certify that the answers given to the foregoing questions are true

to the best of my (our) knowledge. Applicant agrees not to loan or

transfer possession of the license certificate to any person or firm

whatsoever.

Signature(s): Date: 

RETURN COMPLETED APPLICATION AND FEES TO:

 USDA, PACA Division, 

National License Center

1400 Independence Ave, SW 

Room# 1522- S

Washington, DC 20250
Dealer (includes wholesalers, jobbers, distributors, and growers who market produce grown by others) means any person engaged in the business of buying or selling in wholesale or jobbing quantities,

as defined by the Secretary, any perishable agricultural commodity in interstate or foreign commerce. A person who buys potatoes for canning or processing is a dealer whether the potatoes are purchased

within the state or in interstate or foreign commerce.

Interstate or Foreign Commerce means all transactions involving fresh and frozen fruits and vegetables which move between states, and/or other countries and the U.S.

Wholesale or Jobbing Quantities means aggregate quantities of all types of produce totaling one ton (2,000 pounds) or more in weight in any day shipped, received, or contracted to be shipped or 

received

Branch or Additional Business Facility means an office or outlet in a location other than that of the principal or main office of a firm, out of which or through which the firm purchases, sells,

negotiates contracts, solicits, or handles consignments, or otherwise contracts in perishable agricultural commodities including seasonal, part-time and full-time operations. 

The following are definitions of the types of dealers, brokers and commission

merchants that are required to have a PACA license.

Wholesaler , see Dealer (above) 

Foodservice is a dealer that purchases and sells fresh and/or frozen fruits and vegetables in

interstate or foreign commerce for distribution to restaurants, institutions, convenience stores, etc.

These operations commonly also sell non-subject items as well.

Processor is a dealer that purchases fresh and/or frozen fruits and vegetables in interstate or foreign

commerce for canning or processing or sells product in interstate or foreign commerce that has not

had its kind or character changed (i.e., salad mixes, sliced fruit, vegetables, frozen or packed in ice or 

consists of cherries in brine, etc.). However, a processor is not subject if the purchasing and

processing which changes the kind and character are both accomplished within the State where the

produce is grown, even if the processed product is shipped out of the State.

Shipper is a dealer who operates at shipping point and is engaged in the business of 

purchasing produce from growers or others and distributing such produce in commerce by 

resale or other methods, or who handles such produce on joint account with others.

Trucker is a dealer that purchases and sells fresh and/or frozen fruits and vegetables in interstate

or foreign commerce from its truck not as a retailer.

Retailer is a dealer when it purchases wholesale and jobbing quantities, but is only subject to a

PACA license when the invoice cost of all purchases of produce (including frozen potato products

such as French fries) exceeds $230,000 during a calendar year. In computing dollar volume, all

purchases of fresh and frozen fruits and vegetables are to be counted, without regard to quantity

involved in the transaction or whether the transaction was intrastate, interstate or foreign commerce.

Grocery Wholesaler is a dealer primarily engaged in the full-line wholesale distribution and resale 

of grocery and related nonfood items (such as perishable agricultural commodities, dry groceries,

general merchandise, meat, poultry, and seafood, and health and beauty care items) to retailers. This

term does not include persons primarily engaged in the wholesale distribution and resale of perishable

agricultural commodities rather than other grocery and related nonfood items. Specifically, for an

entity to be considered a grocery wholesaler, 50 percent or more of its annual gross sales must be from

the full-line distribution and resale of grocery and related nonfood items, and it cannot have more 

than 50 percent of its sales in perishable agricultural commodities. “Full-line” means that an entity

must be supplying the retailer with a wide range of products such as the grocery and related 

nonfood items specified.

Broker means any person engaged in the business of negotiating sales and purchases of any

perishable agricultural commodity in interstate or foreign commerce for or on behalf of the vendor

or the purchaser, respectively. The 2000 pound quantity limitations do not apply to brokers. They

are subject to PACA licensing with their first interstate or foreign commerce transaction. It is

common in the industry to have fresh produce brokers and frozen produce brokers. Frozen produce

brokers who negotiate contracts for frozen commodities exclusively for the vendor and the invoice

value of the vendor's product does not exceed $230,000 in a calendar year are not subject;

however, frozen produce brokers that are negotiating contracts for the buyer are subject no matter

the invoice price.

Commission Merchant means any person engaged in the business of receiving in interstate or 

foreign commerce any perishable agricultural commodity for sale, on commission, or for or on behalf

of another. For example, a person who receives a truckload of tomatoes; sells the product for a

grower; charges a commission; and remits the net proceeds to the grower. The 2000 pound quantity

limitations do not apply.

Grower is a business that grows its own fruits and vegetables and is not required to be licensed.

However, a grower can be licensed on a voluntary basis and must comply with the PACA law

while licensed.

Growers’ Agent means any person operating at shipping point who sells or distributes produce in

commerce for or on behalf of growers or others and whose operation may include the planting,

harvesting, grading, packing, and furnishing containers, supplies, or other services. The 2000 

pound quantity limitations do not apply, because this type of business is considered a type of 

commissionmerchant.

FTPP-211 (02-18)

Individually owned or Sole Proprietorship means one person has complete ownership and

is fully responsible for all activities.

Corporation is authorized by state law to act as a single entity and is registered with the

secretary/ corporation commission of a state. The corporation can have elected officers and

directors, an appointed registered agent and shareholders. Shareholders can be individuals, other

corporations, LLC, partnerships, etc.

Limited Liability Company or “LLC” is a form of a legal entity where the state law provides for

a firm to be treated as a partnership for tax purposes, while receiving the benefits from personal

liability usually associated with a corporation. LLC’s are also registered with the secretary/

corporation commission of a state. NOTE: LLC’s are required to submit a copy of their Articles

of Organization and Written Operating Agreement with the application

Partnership is a voluntary contract between two or more persons who agree to carry on any

business or venture together, upon the terms of mutual participation in its profits and losses, 

this can be a verbal or written agreement. NOTE: Any change in partners will require a new

license.

Limited Partnership is a partnership consisting of one or more general partners, jointly and

severally responsible as ordinary partners, and by whom the business is conducted, and one or

more special (limited) partners, contributing in cash payments a specific sum as capital, and

who are not liable for the debts of the partnership beyond the funds contributed. Limited

partnerships are required to be registered with the secretary/corporation commission of a state.

NOTE: A change in any general partner will require a new license.

Limited Liability Partnership or “LLP” is a form of a legal entity where the state law provides

for a firm to be treated as a partnership for tax purposes, while its individual partners receive

protection against personal liability of certain partnership liabilities. LLP’s are also registered

with the secretary/corporation commission of a state.

Association is commonly referred to as a Cooperative Marketing Association; a body of persons

united and sometimes acting together without a charter in the pursuit of some common enterprise;

basically a large partnership, but differs from a partnership in that it is not bound by the acts of 

individual partners, but only by those of its manager(s) or trustee(s). the NOTE: While PACA

exempts growers from the licensing requirements, cooperative marketing associations must be

licensed, even if the produce being handled is that solely of its members . 

Trust is a right of property, real or personal, held by one party for the benefit of another; any

arrangement whereby property is transferred with intention that it will be administered by a

trustee for another’s benefit.

Estate is the property, real or personal, which a person has a right or interest and descends by

law to heirs at that person’s death.

Note: The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a)

and the Paperwork Reduction Act of 1995. The authority for requesting this information to be

supplied on this form is the Perishable Agricultural Commodities Act, 1930, as amended, (7 U.S.C.

499a-499t) (499c, 499d). Furnishing the requested information is necessary for the administration of

the Perishable Agricultural Commodities Act program.

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 0581-0031. The

time required to complete this information collection is estimated to average 15 minutes per

response, including the time for reviewing instructions, searching existing data sources, gathering

and maintaining the data needed, and completing and reviewing the collection of information. The

U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities

on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status,

familial status, parental status, religion, sexual orientation, genetic information, political beliefs,

reprisal, or because all or part of an individual's income is derived from any public assistance

program (Not all prohibited bases apply to all programs.) Persons with disabilities who require

alternative means for communication of program information (Braille, large print, audiotape, etc.)

should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of

discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W.,

Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is

an equal opportunity provider and employer.

PENALTY:

Any person who operates without a valid and effective license shall be

liable to a penalty of not more than $1,200 for each such offense and not

more than $350 for each day it continues.

Page 4 of 4 

DEFINITIONS AND TERMS

NATURE OF BUSINESS: (See Question 8) LEGAL STRUCTURES: (See Question 6a)