Early Participation Incentive Program Agreement For Vehicle Emissions Testing Stations
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2TEXAS COMMISSION ON ENVIRONMENTAL QUALITY
Vehicle Emissions Inspection & Maintenance (I/M) Program
Early Participation Incentive Program Agreement for
Vehicle Emissions Testing Stations
SECTION I: Station Owner Information
1. Type of Owner:
Individual
Sole Proprietorship - D.B.A.
Partnership
Corporation
2.Station Owner's Name (If an individual, please print last name first)
3. Mailing Address:
Street
City
State
ZIP
ZIP + 4
4. Telephone Number
5. Fax Number if applicable
(
)
6. Federal Tax ID (9 digits) 7. State Franchise Tax ID Number if applicable
8. Number of Employees
9. Independently Owned and Operated?
Yes
No
0-20
21-100
101-250
251-500
501 and higher
SECTION II: Vehicle Emissions Inspection Station Information
10. Station Name
11. DPS Station No.:
(7 digits)
12. Street Address:
(No P.O. Boxes)
City
State ZIP
ZIP + 4
13. Mailing Address
City
State ZIP
ZIP + 4
14. Telephone Number
15. Fax Number if applicable
(
)
(
)
16. County This Station Is In:
SECTION III: Preparer Information
17. Name
18. Job Title
19. Telephone Number
20. Fax Number if applicable
(
)
(
)
TCEQ-I/M (09/02)
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Parent category: Business