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Home My WebLink AboutDL-2 Application for License- ADA 04/10 DL-2 State of Hawaii DEPARTMENT OF AGRICULTURE Commodities Branch Quality Assurance Division 1851 Auiki Street Honolulu, Hawaii 96819-3100 APPLICATION FOR LICENSE - DEALERS IN FARM PRODUCE Please read attached sheet before completing application. FOR OFFICE USE ONLY New ______ Update ________ Receipt No ________________ Receipt Date ______________ Amount Paid ______________ Penalty Amount ____________ Date Lic Issued ____________ SECTION A. TO BE COMPLETED BY ALL APPLICANTS 1. NAME OF BUSINESS: (Please print) 2. PLACE OF BUSINESS: (No. and Street, City, State, ZIP) 3. CLASS OF BUSINESS: (See attached sheet for definitions and check all applicable classes. ) 4a. BUS PHONE: 5. MAILING ADDRESS: (If same as block 2, write “Same”.) This is a corporate or executive office (see instructions). 6. HAWAII GROWN FARM PRODUCTS OBTAINED OR PURCHASED DIRECTLY FROM PRODUCER: (Check all applicable products.) PLANTS FRESH FRUITS OR VEGETABLES LIVESTOCK OR LIVESTOCK PRODUCTS FLOWERS POULTRY EGGS COFFEE 8. DATE BUSINESS STARTED: 9. BUSINESS IS: (CHECK APPLICABLE SQUARE AND COMPLETE BLOCKS 10 TO 13 AS REQUIRED.) SOLE OWNER PARTNERSHIP CORPORATION OR ASSOCIATION Print NAME and home ADDRESS of Owner in blocks 10 and 11. Indicate above, type of partnership (GENERAL, LIMITED or SPECIAL) Print NAME and home ADDRESS of all partners in blocks 10 and 11. Print NAME, home ADDRESS and TITLE of all directors or officers and holders of more than ten percent of outstanding stock and the PERCENT- AGE OF STOCK held by each in blocks 10 to 13. 10. NAME 11. HOME ADDRESS 12. TITLE PERCENT STOCK 13. COMMISSION MERCHANT BROKER AGENT DEALER PROCESSOR RETAIL MERCHANT 7. DATE FIRST HANDLED ABOVE FARM PRODUCT(S) AND BECAME SUBJECT TO LICENSING: (Month/Day/Year) 4b. BUS FAX: 4c. EMAIL: OTHERS (Note: Attach separate sheet if additional space is needed.) PLEASE SEE REVERSE SIDE SECTION B. TO BE COMPLETED BY APPLICANT WITH BRANCH STORE(S) See instruction sheet 14. NAME, ADDRESS AND PHONE NUMBER OF EACH BRANCH STORE. A separate application must be completed for each Branch Store established subsequent to the filing of this application. DO NOT WRITE IN LIC. NO. BLOCK, for office use only. MAIN OR PARENT STORE 5. PHONE:PHONE: LIC. NO. LIC. NO. 6.1. BRANCH STORES PHONE:LIC. NO. LIC. NO.PHONE: 2. 7. PHONE:PHONE: LIC. NO.LIC. NO. 3. 8. PHONE: LIC. NO. PHONE: LIC. NO. 4. 9. LIC. NO.PHONE: PHONE: LIC. NO. (Note: Attach separate sheet if additional space is needed) SECTION C. TO BE COMPLETED BY ALL APPLICANTS 15. BANKING REFERENCE: Name and Branch of Bank 16. NAME OF PERSON AUTHORIZED TO RECEIVE AND ACCEPT SUMMONS AND LEGAL NOTICES. AGENT OR COMMISSION MERCHANT APPLICANTS SEE ATTACHED INSTRUCTIONS FOR ADDITIONAL REQUIREMENTS. COMMISSION MERCHANT or BROKERS ATTACH SURETY BOND for $3,000.00. LICENSE FEE (See attached sheet for instructions.) Commission Merchant, Agent, Broker, Dealer or Processor (each)........$40.00 Signature of Applicant Retail Merchant.......................................$10.00 Branch Store.............................................$5.00 Title Penalty: See instruction sheet Make check payable to: HAWAII DEPT. OF AGRICULTURE and mail to : COMMODITIES BRANCH 1851 Auiki Street Honolulu, HI 96819-3100 Date REMINDER: DID YOU SIGN THIS APPLICATION? 04/10 DL-2a INFORMATION AND INSTRUCTIONS APPLICATION FOR LICENSE DEALERS IN FARM PRODUCE GENERAL LICENSE REQUIREMENT A license from the HAWAII DEPARTMENT OF AGRICULTURE is required if you handle or sell any HAWAII GROWN Agricultural Product, such as... PLANTS FLOWERS ISLAND EGGS or POULTRY FRESH FRUITS or VEGETABLES ISLAND LIVESTOCK or LIVESTOCK PRODUCTS and the product was OBTAINED OR PURCHASED BY YOU DIRECTLY FROM A HAWAII FARMER OR GROWER. CLASS OF BUSINESS - DEFINITIONS (Item 3 of application) COMMISSION MERCHANT means any person who receives on consignment or solicits from the producer thereof any farm product for sale on commission on behalf of such producer, or who accepts any farm product in trust from the producer thereof for the purpose of resale, or who sells or offers for sale on commission any farm product, or who in any way handles for the account of or as an agent of the producer thereof any farm product. DEALER means any person, other than a commission merchant, who solicits or obtains possession or control of any farm product at a specified unit price from a producer thereof for resale in its natural state to other than the consumer thereof. BROKER means any person, other than a commission merchant or dealer, who negotiates the purchase or sale of any farm product. A broker may not obtain possession of any farm product involved. AGENT means any person who, on behalf of any commission merchant, dealer, broker, processor or retail merchant receives, contracts for or solicits any farm products from a producer thereof, or who negotiates the consignment or purchase of any farm product on behalf of any commission merchant, dealer, broker, processor or retail merchant. PROCESSOR means any person who contracts for or obtains possession of any farm product from the producer thereof for resale in a processed form, but shall not include hotels, restaurants, or other persons furnishing meals, nor shall it include any person who processes any farm produce solely for sale directly to a consumer. RETAIL MERCHANT means any person who solicits or obtains from a producer thereof title, possessions or control of any farm product at a specified unit price for sale at retail to a consumer. For the purpose of this definition, sales to the United States Armed Forces, restaurants, hotels, hospitals or institutions are not retail sales. BRANCH STORE LICENSE (Section B, Item 14 of application) BRANCH STORE means any additional store owned and operated by a person subject to licensing which conducts the same class of business. A license is required for each Branch Store and may be obtained by the main store or parent company. A separate license is not required for the executive or corporate office, if listed in Item 1 of the application. The main store or parent store shall be the first store listed in Item 14 and shall pay the proper license fee required for its class of business. All other stores listed in Item 14 shall be classified as branch stores providing they are under the same corporate charter, partnership or ownership as the main store. (over) LICENSE FEES If your business falls under only one class of business, pay only that specified fee. If it falls under more than one class of business, the general rule is that no additional license fee is required if the license fee for a class of business having a higher fee is paid. Following are examples: a. A COMMISSION MERCHANT shall pay a $40 license fee. b. A DEALER, PROCESSOR, BROKER or AGENT shall pay $40 for each classification. They may also operate as a Retail Merchant with no additional fee. c. A RETAIL MERCHANT shall pay a $10 license fee and can operate only as a retail merchant. d. Each BRANCH STORE must pay a $5 fee and can conduct the classes of business for which the main store is licensed. PENALTY: If the date in Item 7 of the application is more than thirty days from the date of filing the application, a penalty will be in effect. Please contact Commodities Branch personnel prior to calculating your license fee. ADDITIONAL REQUIREMENTS COMMISSION MERCHANT OR BROKER CLASSIFICATION Form DL-3 must be completed and submitted with the application. Commission Merchants and Brokers are also required to execute and deliver to the Director, a surety bond in the sum of $3,000.00. A printed bond form DL-10 is available on request. AGENT CLASSIFICATION Form DL-3 must be completed and submitted with the application. An agent’s license expires with that of his principal. SIGNATURE DON’T FORGET TO SIGN AND DATE YOUR APPLICATION, Mail with your payment to: COMMODITIES BRANCH 1851 Auiki Street Honolulu, HI 96819-3100 IF YOU HAVE ANY QUESTIONS, PLEASE TELEPHONE THE COMMODITIES BRANCH OFFICE: HONOLULU KONA MAUI KAUAI 832-0709 323-7589 873-3554 274-3073