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Commercial Industrial Hemp Processor Application (Submit Online)
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This form has been modified since it was saved. Please review all fields before submitting.
Application Type
New
Renewal
COMPLETE ALL 9 SECTIONS, REFER TO K.A.R. 22-26-2 FOR GUIDELINES
Section 1 Legal Name
For background purposes, use full legal name. This name will also be printed on applicant’s permit.
Last Name
First Name
MI
Section 2 Applicant's Current Permit Number (if renewal)
Permit Number
Section 3 Personal Information
DOB
DOB
Age
In years
Gender
Male
Female
Last 4 digits of Social Security Number
Drivers License Number
State
U.S. Citizen
Yes
No
If not a U.S. citizen, please provide Alien Registration Number
Have you been convicted of a felony?
Yes
No
Section 4 Contact Information
Home Phone Number
Mobile Number
Email Address
Section 5 Business Information
Business Name
Address
City
State
Zip Code
Latitude and Longitude of Location
Section 6 Physical & Mailing Address
Physical address of any buildings that are owned/leased by the company and used in any part of the processing operation.
Physical
Address
City
County
State
Zip Code
Mailing
For official correspondence with our office.
Address
City
County
State
Zip Code
Section 7 Officers, Proprietors, Partners of Entity, and Employees
Each owner of more than a 10% interest in the processing operations, as well as employees.
Type
Proprietor
Partner
Officer
Employee
Last Name
First Name
MI
DOB
DOB
Age
In years
Gender
Male
Female
Last 4 Digits of Social Security Number
Driver's License Number
State
U.S. Citizen
Yes
No
If not a U.S. citizen, please provide Alien Registration Number
Have you been convicted of a felony?
Yes
No
Type
Proprietor
Partner
Officer
Employee
Last Name
First Name
MI
DOB
DOB
Age
In years
Gender
Male
Female
Last 4 Digits of Social Security Number
Driver's License Number
State
U.S. Citizen
Yes
No
If not a U.S. citizen, please provide Alien Registration Number
Have you been convicted of a felony?
Yes
No
Type
Proprietor
Partner
Officer
Employee
Last Name
First Name
MI
DOB
DOB
Age
In years
Gender
Male
Female
Last 4 digits of Social Security Number
Driver's License Number
State
U.S. Citizen
Yes
No
If not a U.S. citizen, please provide Alien Registration Number
Have you been convicted of a felony?
Yes
No
If more space is needed for individuals, upload their complete information as supporting documentation below.
Section 8 Type of Hemp Processing Method Used
Ethanol
CO2
Cold Press
Agricultural Processor
A brief description of the industrial hemp processing methods that will be used, activities that will be undertaken, and finished products planned for production.
Section 9 Applicants Signature
Under the penalties imposed by K.S.A. 21-3805, I declare that I have examined this application and any documents submitted in support thereof, and to the best of my knowledge and belief, they are true, correct and complete. I also certify that I am familiar with all published state laws and local ordinances relating to hemp processing for the location(s) in which I intend to do business.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
Please upload supporting documents
Only PDFs are accepted
Supporting Documentation
Additional officers, proprietors, partners of entity and/or employees.
Policies and Procedures Manual
Fingerprint cards, signed Consent to Search forms and criminal background checks for applicant, additional officers, proprietors, partners of entity and/or employees
Code Footprints
Supporting documentation can be provided after application is submitted if necessary.
Supporting documents can be submitted to ksfm_hemp@ks.gov after application is filed.
Once your application is approved, you will be notified of any fees that are due.
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