Dairy Application

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Step 2 - Milk Hauler Application

Applicant Information

Applicant Type * FAIRS Individual Partnership Association Government Agency Corporation Co-operative Association Political Subdivision Corporate Affilate/Subdivision Other Business Unit Seasonal Producer Organic Certified

First Name * 

MI

Last Name * 

Firm Name *

Address * 

Address Con't

City * 

State * ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND AND LABRADOR NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON

Zip *

County * ADAMS ALLEN ASHLAND ASHTABULA ATHENS AUGLAIZE BELMONT BROWN BUTLER CARROLL CHAMPAIGN CLARK CLERMONT CLINTON COLUMBIANA COSHOCTON CRAWFORD CUYAHOGA DARKE DEFIANCE DELAWARE ERIE FAIRFIELD FAYETTE FRANKLIN FULTON GALLIA GEAUGA GREENE GUERNSEY HAMILTON HANCOCK HARDIN HARRISON HENRY HIGHLAND HOCKING HOLMES HURON JACKSON JEFFERSON KNOX LAKE LAWRENCE LICKING LOGAN LORAIN LUCAS MADISON MAHONING MARION MEDINA MEIGS MERCER MIAMI MONROE MONTGOMERY MORGAN MORROW MUSKINGUM NOBLE OTTAWA PAULDING PERRY PICKAWAY PIKE PORTAGE PREBLE PUTNAM RICHLAND ROSS SANDUSKY SCIOTO SENECA SHELBY STARK SUMMIT TRUMBULL TUSCARAWAS UNION VAN WERT VINTON WARREN WASHINGTON WAYNE WILLIAMS WOOD WYANDOT OUT OF STATE Monongalia Kanawha

Phone (no dashes) *

Email

License Type

 Grade A Bulk Milk:  owns or leases a vehicle or conveyance to transport Grade A raw milk in bulk from the Grade A producer to a Grade A receiving, transfer or processing facility

 Grade A Can Milk:  owns or leases a vehicle or conveyance to transport Grade A raw milk in cans from the Grade A producer to a Grade A receiving, transfer or processing facility

 Manufacture Bulk Milk:  owns or leases a vehicle or conveyance to transport manufacture raw milk in bulk from the manufacture producer to a manufacture receiving, transfer or processing facility

 Manufacture Can Milk:  owns or leases a vehicle or conveyance to transport manufacture raw milk in cans from the manufacture producer to a manufacture receiving, transfer or processing facility

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