Form Cos013 - Cosmetology Mobile Salon License Application (Page 2 of 6) in pdf

PO Box 12157  Austin, Texas 78711-2157

(800) 803-9202  (512) 463-6599  FAX (512) 475-2871

 cs.cosmetologists@tdlr.texas.gov

COSMETOLOGY MOBILE SALON LICENSE APPLICATION

YOU MUST MEET ALL REQUIREMENTS WITHIN 12 MONTHS OF THE FILING DATE, OR THE APPLICATION WILL BE TERMINATED.

APPLICATION FEE: $106 (FEE IS NON-REFUNDABLE)

PAYMENTS MUST BE IN THE FORM OF A CASHIER’S CHECK OR MONEY ORDER PAYABLE TO TDLR

ALL INFORMATION MUST BE TYPED OR PRINTED IN BLACK INK

1. Salon Name:

_______________________________________________________________________________________________

2. Salon Type:

Beauty Salon

Manicure (only)

Esthetic (only)

Esthetic/Manicure

(ck one only)

Wig Salon

Weaving

Eyelash Extension Salon

3. Mobile Salon’s Mailing Address:

(USED TO RECEIVE MAIL FROM TDLR) (A PO box is allowed for this address.)

Number, Street Name, Apartment Number

________________________________________________________________________________________________________________________________________________________________

City

State

Zip Code

4. Phone Number:

5. Email Address:

(_______________) ____________________________________________________

_______________________________________________________________________________________

(Ex: ) See instruction sheet for disclosure information

Area Code

Phone Number

6. Mobile Salon’s Physical Address:

(where unit will be located when not in use)

Number, Street Name, Suite Number/Apartment Number

________________________________________________________________________________________________________________________________________________________________

City

State

Zip Code

8. Phone Number:

7. Fax Number:

(_______________) ____________________________________________________

Area Code

Phone Number

Area Code

Phone Number

9. Tracking Method: What method will be used to let the Department track the location of the mobile salon?

Global Positioning System (GPS)