DOVER DE 19901 1 Legal name of business to appear on permit Address to mail permit include business name if different from above 2 Do you manufacture bedding products YES NO If YES list physical location City State Country of bedding manufacturing s ID: 38091
Download Pdf The PPT/PDF document "DELAWARE HEALTH AND SOCIAL SERVICES Divi..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
��DELAWARE HEALTH AND SOCIAL SERVICESDivision of Public HealthCommunity Environmental Health Services 417 FEDERAL STREET ●JESSE COOPER BUILDING ● DOVER ● DE ● 199TELEPHONE (302) 744546FAX (302) 739839 MATTRESS, PILLOW AND BEDDING PROGRAM TITLE 16 DELAWARE ODECHAPTER 21 APPLICATION FOR INITIAL PERMIT AND PERMIT RENEWALTO MANUFACTURE OR SHIP BEDDING PRODUCTS INTO DELAWA Answer allquestions and return to:OFP (Print legibly)JESSE COOPER BUILDING417 FEDERAL ST.DOVER, DE 19901 1. Address to mail permit (include business name if different from above): Do you manufacture bedding products?YES___*NO___ If YES: list physical location (City, State, Country) of bedding manufacturing sites: Do you distribute bedding products manufactured by others? YES___*NO___ If YES, list the Business Names and Locations of suppliers whose products you distribute.(Use extra sheets if needed.) List types of bedding products shipped into Delaware: ► Attach one (1) Law Label bedding tag with niform egistry umber (URN) For both Initial and renewal. No permit will be issued without an original law label attached to application. URN_____________ ► Enclosecheck or money order in amount of payable to STATE OF DELAWARE ATTENTION OVERSEAS COMPANIES: Enclose money order or bank draft withUS DOLLARS IMPRINTED ON THE MONEY ORDER OR BANK DRAFT Payments with handwritten US Dollar amounts cannot be accepted from outside U.S. Check No. Contact Information: (Please print legibly and sign in ink) Name of person to whom permit will be sent: Phone No & Extension__________________________________ Fax No. Note: This office cannot place telephone calls or send faxes outside U.S. MAIL Address: Applicant Do not write below the dotted line Date Approved: ____________ Date Permit Issued:_____________ Bedding Permit Number___________________ Signature of Official: _______________________________________ PAID STAMP: _________________________