Closed Business Form - Version 2
If you are no longer operating your PACFA facility please complete the following questions and submit your form. Your business will be closed in our system.

If you plan on operating at a new location please submit a new application.
My business will no longer be in operation as of: *
MM
/
DD
/
YYYY
Facility License Number *
The license numbers starts with either AgLicense ID or PL and is located on your license. Inspectors please use the PL number if the facility has one.
Your answer
Facility Name *
Your answer
Facility Address *
Your answer
Name of person completing this form *
Your answer
If you are an inspector and are completing this form please reference the inspection that the closed facility is documented in.
Your answer
Email Address of person reporting business as closed *
Your answer
Reason for Closing *
If you were licensed as any of the following categories; Any type of Animal Breeder, Retailer, Wholesaler or Shelter please tell us what species you still have and how many of each species. The count should include all animals (personal pets, breeding animals, co-owned animals, retired animals, etc...) that will remain in your possession at the time of closing your business with PACFA. *
If this does not apply to you please enter N/A
Your answer
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