B UREAU OF O CCUPATIONAL AND INDUSTRIAL S AFETY H ARRISBURG, PA 1 7 1 2 0 717-787-6848 Fax: 717-787-6925 www.dli.state.pa.us APPLICATION FOR REGISTRATION BEDDING AND UPHOLSTERY I, or we, hereby make application for registration as: ______ MANUFACTURER ANNUAL FEE — $50.00 ______ IMPORTER* plus a Yearly Report must be submitted paying a fee of 2½¢ for each article shipped into or sold in the Commonwealth of Pennsylvania. ______ SUPPLIER (Supplies bulk filling material to the trade) ______ VENDOR (Person who brings goods into the state for sale. Example: sales from trucks, etc.) NATIONAL UNIFORM REGISTRY NUMBER____________________________________________________ Manufacturer, Importer, etc., must attach two current Law labels if using a registry number issued by another state; also copy of certificate issued by that state. List Products ________________________________________________________________________________ *IMPORTERS NOTE: NAME OF FOREIGN MANUFACTURER ________________________________________________________ COMPLETE ADDRESS _______________________________________________________________________ (see Section A CITY ________________________________________ COUNTRY _________________________________ on Reverse Side) FAX (_____) ___________________ E-MAIL __________________________________________________ ______ RENOVATOR REGISTRATION & PERMIT FEE — $60.00 ______ SECONDHAND (see Section B on Reverse Side) ______ RENTAL ______ AUCTIONEER (AUCTIONEERS ONLY) - Dept. of State Auctioneer’s Number AU___________ L (Name shown below must be same as on Auctioneer’s License) NAME OF FIRM _____________________________________________________________________________________ ADDRESS __________________________________________________________________________________________ CITY _________________________________________________ STATE ______ ZIP CODE _________________ CONTACT PERSON _________________________________________________________________________________ DATE __________________ SIGNATURE _____________________________________________________________ PHONE (_____) ___________________ PRINT NAME & TITLE ___________________________________________ FAX (_____) ___________________ FEDERAL ID NUMBER ________ - ___________________________________ E-MAIL _____________________________________________________________________________________________ NOTE: Please make all checks payable to “Dept. of Labor & Industry” (US Funds Only) Mail to: Dept. of Labor & Industry, Bedding & Upholstery Section, Room 1619, 7th & Forster Streets, Harrisburg, PA USA 17120-0019 LIBU-32 REV 5-01 Section A The Department has permitted importers to hold Bedding & Upholstery registration on behalf of foreign manufacturers. However, the Department does not permit an importer to hold a single registration while importing from multiple foreign manufacturers under the single registration. Penn- sylvania requires each manufacturer to be separately registered with the Department. The following options for registration are available to foreign manufacturers: 1. The manufacturer may register directly with the Department at the foreign manu- facturer’s location. This is identical to the requirement for domestic manufacturers, or 2. An importer may hold a Bedding & Upholstery registration on behalf of each foreign manufacturer represented. Please note that the importer is required to hold a separate registration for each foreign manufacturer represented. The Department does not per- mit “pooling” of registrations. When an importer holds the registration on behalf of the foreign manufacturer, the Registration Certificate will show the name of both the importer and the foreign manufacturer. Section B Two liquid sprays have been approved by the Industrial Board. They are “MICROBAN X-580 with Tracer” and “STERI-FAB”. If you intend to employ another method of disinfecting or sterilization (Section 47.27 of the Regulations), you must contact this office for further information.