Form Ap-168 - Texas Application For Customs Broker License Page 2

Download a blank fillable Form Ap-168 - Texas Application For Customs Broker License in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ap-168 - Texas Application For Customs Broker License with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

PRINT FORM

CLEAR FORM

Texas Application for

AP-168-2

(Rev.1-15/7)

Customs Broker License

• Please read instructions.

• Type or print.

• Do NOT write in shaded areas.

Page 1

1. Licensed Customs Broker Agreement - The applicant, in consideration of the issuance of the Texas Customs Broker License, agrees

and afﬁrms:

a. that the applicant is a responsible Licensed Customs Broker issuing valid export certiﬁcations for merchandise being exported from the United States;

b. that the export certiﬁcations will not be used in a manner that violates a provision of the Tax Code or the Comptroller’s rules;

c. that a copy of the applicant’s U. S. Customs Broker’s license is provided to the Texas Comptroller of Public Accounts at the time of application;

d. that the Comptroller of Public Accounts may suspend or revoke a Texas Customs Broker License to issue export certiﬁcations under this section

for good cause;

e. to properly document the issuance of export certiﬁcations and stamps, and to purchase new stamps as described in the Comptroller’s rules;

f. that upon request, the licensed Customs Broker will make records available to the Comptroller or his/her authorized representative in the state

of Texas and will cooperate with the Comptroller or his/her authorized representative in the examination of the records;

g. that copies of each employee’s power of attorney to issue export certiﬁcations in the name of the applicant are included;

h. information in this document and any attachments is true and correct to the best of my knowledge and belief; and

i. I understand that computer system passwords are conﬁdential. I will not disclose (to any person) any password(s) which I am given or devise, and

I will not write down such password(s) or post them where they may be viewed by others. I understand that I am responsible for any computer

transactions performed as a result of access authorized by use of any passwords that I receive or devise. I agree to abide by all written conditions

and restrictions imposed by the Comptroller’s Information Security Ofﬁce. I agree NOT to attempt to circumvent the Comptroller’s computer

security system. I understand that use of a password not issued speciﬁcally to me or to a group of which I am a member is expressly prohibited. I

also understand that failure to observe these restrictions may constitute a Breach of Computer Security, and that such an offense may constitute

a ﬁrst-degree felony. Tex. Pen. Code §33.02.

Type or print name of licensed customs broker

Broker, ofﬁcer or authorized agent

Date of application

WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to con-

duct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online at http://

You may also want to contact the municipality and county in which you will conduct business to determine any local govern-

mental requirements.

2. Legal name of applicant as registered with the U. S. Customs Service

3. Mailing address where you will receive mail from the Texas Comptroller of Public Accounts

Street and number, P.O. Box or rural route

Taxpayer number

City

State

County

ZIP/Postal code

4. Enter your Social Security number if you are a sole owner ...................................................................

5. Enter your Federal Employer Identiﬁcation Number (FEIN), if any ..................................................

6. Daytime phone where applicant may be reached (Area code and number) ...................................

7. Enter the number of the license issued by the U. S. Customs Service ..........................................................................................

8. Enter your Texas taxpayer number for reporting any Texas tax or your

Texas Vendor Identiﬁcation Number if you now have or have ever had one .........................................

9. Enter your email address .......

10. If your business is a corporation, list all principal ofﬁcers. (Attach additional sheets as necessary.)

Name

Title

Phone (Area code and number)

Home address

City

State

ZIP code

SSN or FEIN