Fertilizer Registration Form

DEPARTMENT OF PLANT INDUSTRY
511 WESTINGHOUSE ROAD
PENDLETON, SC 29670
864-646-2140
Fertilizer Registration Form
(Registration Year: July 1st – June 30th)
Instructions: Please indicate your name and mailing address in the space below as it appears on your product label. Determine your
license fee from the Fee table and include payment with this form. Checks should be made payable to Clemson University. All
registrants must obtain license whether registering bulk, specialty, or both. For specialty fertilizer, please submit a product label for
each product.
Include nitrogen source for each product using the following codes: U = Urea, AS = Ammonium Sulfate, AM = Ammonium Nitrate,
OS = All other sources. If all bulk products use the same source, you need not list each brand. For products containing waste materials
and/or industrial by-products, please provide the appropriate information*. You are required to submit any changes to this information
as soon as they occur. Questions you may have in completing this form may be directed to 864-646-2140.
Company Name__________________________________________________________________________________
Address __________________________________________________________Phone (
)___________________
________________________________________________________________________________________
Contact Person _________________________E-Mail_________________________Date _______________________
PLEASE ANSWER ALL OF THE QUESTIONS BELOW. FAILURE TO DO SO WILL RESULT IN A DELAY IN
PROCESSING.
Does the business represented by this application for registration intend to sell any of the following products in South Carolina?
You must answer all of the following items:
1) Ammonium Nitrate
Yes No
2) Urea
Yes No
3) Anhydrous Ammonia
Yes No
*Do any of the products requested for registration contain waste materials or industrial by-products? Yes_____ No_____
If yes, please provide: (1) a description of the waste materials and/or industrial by-products; and (2) a detailed description of the process that
generates the waste and any by-products. Please provide any other analytical data that may be available for these processes. If biosolids are used,
submit documentation that the biosolids meet the federal 40 CFR 503 requirements for classification as a Class “A-EQ” biosolid. The confidentiality
of all information submitted will be maintained. Please provide the appropriate information as an attached document.
Product Name
(Include EPA Reg. # for products containing pesticides)
FEE TABLE
Tonnage Volume (from previous year)
0 – 5,000
5,000 – 25,000
25,000 or greater
Specialty Fertilizer
(sold in packages 10 lbs. or less)
AMOUNT PAID: $
Package
Weight
Specialty (S) or
Bulk (B)
Nitrogen Source
For Office Use Only:
License Fee
$100 / year
$200 / year
$400 / year
$60 / product per year +
license fee
Date approved:__________________
By:___________________________________
Expiration Date:____________________