Form Ap-168 - Texas Application For Customs Broker License Page 3

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Texas Application for
AP-168-3
(Rev.1-15/7)
Customs Broker License
• Please read instructions.
• Type or print.
• Do NOT write in shaded areas.
Page 2
11. Legal name of applicant (same as Item 2)
Texas Customs Broker license number
Complete the following information for each active business location where export certifications will be issued.
(Attach additional sheets as necessary.)
12. Business name
13. Business location (Street and number —do not use P.O. Box or rural route)
City
State
ZIP code
County
T X
YES
NO
14. Is your business located inside the boundaries of an incorporated city? ...................................................
Month
Day
Year
15. First business date ..............................................................................................................................................................................
16. Business phone (Area code and number) .............................................................................................................
17. Business name
18. Business location (Street and number—do not use P.O. Box or rural route)
City
State
ZIP code
County
T X
YES
NO
19. Is your business located inside the boundaries of an incorporated city? ...................................................
Month
Day
Year
20. First business date ..............................................................................................................................................................................
21. Business phone (Area code and number) .............................................................................................................
22. Business name
23. Business location (Street and number—do not use P.O. Box or rural route)
City
State
ZIP code
County
T X
YES
NO
24. Is your business located inside the boundaries of an incorporated city? ...................................................
Month
Day
Year
25. First business date ..............................................................................................................................................................................
26. Business phone (Area code and number) .............................................................................................................
27. Business name
28. Business location (Street and number—do not use P.O. Box or rural route)
City
State
ZIP code
County
T X
YES
NO
29. Is your business located inside the boundaries of an incorporated city? ...................................................
Month
Day
Year
30. First business date ..............................................................................................................................................................................
31. Business phone (Area code and number) .............................................................................................................

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