- Home »
- Welcome Dealers »
- Statement of Use »
- Statement of Use Form
Statement of Use Form
STATEMENT OF NON-DIVERSION OF AQUATIC REMEDIES & MEDICATED FOOD INTENDED FOR ORNAMENTAL FISH.
This is to certify that the person and company listed below will not transfer any aquatic remedies, antibiotics, chemicals, treatments or medicated foods intended for ornamental fish purchased from Aqua Meds to the food-fish industry or to a person who does not limit their application to the aquatic ornamental species not intended for human consumption. The person listed below is aware that such products are intended only for the ornamental fish industry and will inform his employees and everyone using Aqua Meds products and medicated foods that they are to be used on ornamental fish only and the above products purchased from Aqua Meds will not be used or sold for human or veterinary medicine.
| Company Name: | |
|---|---|
| Address: | |
| Phone: | |
| Fax: | |
| Email: | |
| Date: | Feb 06, 2012 |
| Name of Individual: | |
| Position/Title: | |
| Signature: |