Please fill out this form in it's entirety. You should receive a reply within 2 business days containing your Login Name and Password. You must be the permit owner or a contact on the permit. If you are not a contact or the owner of the permit below, please fill out this PDF form and fax to our offices at (805) 934-6202. A confirmation email will be sent with the login information. Thank You!

Contact Information

First Name *

Last Name *

Company Name *

E-mail

Phone *

Address *

City *

State *

Zip Code *

Pesticide Permit #

Owner:

Yes

Verification

IMPORTANT: If the confirmation screen does not appear after you submit, then the request was not successful. Please try again. If still unsuccessful, you may be using an incompatible browser. You can make your request by calling our offices. If you're having trouble with your login, email us at [email protected] for a quick reply. Thank You!