Firm Registration Initial Application Form
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1
2
3FORM C
(Version: 02.15.15)
T
B
P
G
EXAS
OARD OF
ROFESSIONAL
EOSCIENTISTS
P.O. Box 13225 • Austin, Texas 78711 • (512) 936-4400 • fax (512) 936-4409
Firm Registration Initial Application Form
Please complete this form by typing or printing legibly in ink. This form applies to corporations, partnerships, co-
partnerships, joint stock associations, and certain sole proprietors, as specified in TBPG Rule §851.30. Please
complete this form and mail it with the applicable fee to the Board at the address indicated above. Complete all
sections, marking N/A where applicable. The application fee is non-refundable and must be submitted with the
application in the form of a check or money order made payable to the Texas Board of Professional Geoscientists
(TBPG).
SECTION I. Firm Legal Name:
DBA (if applicable):
Headquarters Business Address:
Street
City
State
Zip
Main Phone: (
)
Fax: (
)
County:
Hours of Operation: __________________________
Mailing address (if different from headquarters address) :
Street or P O Box
City
State
Zip
Professional Geoscientist (P.G.) in responsible charge of geoscience work in Texas at this office:
Name: _________________________ TX P.G. License #: _________ Expiration Date: ____________
Phone:
Fax:
E-mail:
SECTION II. Registration Fee:
$300 Registration Fee
(Firm, Corporation, Joint Stock Association, Partnership, Co-partnership, or other)
S.O.S. File #:
(required for all firms except sole proprietors)*
*Any business operating in Texas under any type, other than a sole proprietorship, is required to obtain a certificate of authority
through the Office of Secretary of State (SOS). If operating under a name other than that which is filed with the Secretary of
State, an Assumed Name Certificate (or a DBA) must be filed with the County Clerk, and both the SOS number and instrument
number must be provided. For more information on obtaining an SOS File number, call the Secretary of State at 512/463-5555.
County Clerk Instrument #: _________________________
(for sole proprietors, as applicable) **
Filed in _____________________ County
**A sole proprietorship is a single individual that operates a business, owns all assets, and is personally liable for all debts. If
operating as a sole proprietorship under a name that does not include the sole proprietor’s last name, an Assumed Name
Certificate (or a DBA) must be filed with the County Clerk in each county in which the business operates, or offers or performs
services. The Assumed Name Certificate instrument number must be provided.
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Austin Headquarters: Wm. P. Hobby, Jr. Bldg. • 333 Guadalupe, Tower 1, Suite 530 • Austin, Texas 78701
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