Restricted Use Pesticide Purchase Request

Request Fumigant Purchase

Submit your product request and applicator license for FSS review. No payment is taken when you submit this form — FSS verifies your license, then finalizes the order with you.

* Required

Your request

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Request only — not an orderEdit cart

Applicator license

Enter the details exactly as they appear on the license. FSS verifies them before any sale.

Applicator name

Company / facility(optional)

Phone

So FSS can reach you about this request.

Issuing state

License type

License number

Certification categories(optional)

Expiration date

Photo or PDF of the current license

Upload your current applicator license

JPEG, PNG, HEIC, or PDF · up to 10 MB · one file

Choose file

Shipping & contact

Where the fumigant will be delivered and who is authorized to receive it.

Ship-to address

Receiver

Person who will accept delivery.

Alternate receiver(optional)

How can the delivery site receive a pallet?

Fumigants ship palletized as hazmat LTL freight — this tells FSS whether a liftgate is needed.

Request details

A sentence is enough — this helps FSS confirm the right product and package.

What will this product be used for?

Notes for FSS(optional)

Acknowledgment & signature

Important fumigant safety information

These products are federally Restricted Use Pesticides that release toxic phosphine gas, with serious inhalation, fire and handling hazards.
They may be purchased and used only by (or under the direct supervision of) certified applicators.
Gas monitoring, respiratory protection and other safety requirements come from the product labeling — read and follow the current Applicator's Manual, and prepare and follow the required Fumigation Management Plan.
You are responsible for lawful handling, application, storage and disposal.

Acknowledgment — required

I have read, understand, and agree to this acknowledgment: I certify that the license information I submitted is current and accurate. I will read and follow the current Applicator's Manual / product labeling for each fumigant in this request, and I will prepare and follow a Fumigation Management Plan where the labeling requires one. I understand FSS will verify my license before this order can be completed.Required

Your typed legal name (signature)

No payment will be processed when you submit this request. FSS will contact you at the phone number above.

What happens next

Submit your request

Provide your applicator license, shipping and intended-use details.

FSS reviews your request

We verify license information, product availability and shipping requirements.

FSS confirms next steps

We follow up with order details, pricing and next steps before shipment.

Back to cart

Item added to your cart