Form No. Pa-400 - Instructions For Application For Pesticide Applicator License Page 3

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Instructions for PA-400 Application for Pesticide Applicator License
Page 3 of 3
SECTION F
1. OUT-OF-STATE APPLICANTS ONLY
Check either the Texas Secretary of State or the “Other” box and enter the resident agent’s contact information. Only fill
out the Resident Agent contact information if the Texas Secretary of State box is not checked. If the address provided in
section B is out of state resident agent information is REQUIRED.
SECTION G
1. PAYMENT
NOTE: Texas Department of Agriculture accepts only checks, cashier's checks, or money orders.
Licenses are not valid until you receive confirmation from TDA. Confirmation may be by phone call, e-mail or mail.
License fees:
$120 for Noncommercial
$ 12 for Noncommercial Political Subdivision
$ 60 for Private
Check method of payment. Enter check number, cashier's check number or money order number. Enter amount remitted.
Please remit to: Texas Department of Agriculture, P.O. Box 12076, Austin, TX 78711-2076.
SECTION H
1. SIGNATURE
After reading the summary, print and sign your name, and date the form. Your signature here indicates that you have read
the summary and that you are aware of your responsibilities regarding the issuance of the requested license.
SECTION I
Please note that an incomplete application may result in processing delays.
1. CHECKLIST
Check all boxes to verify you have completed the application process and attached/enclosed the necessary items (e.g.,
payment, reports, schedules, labels, etc).
Licensing Department
Revised 01/16/08
Administrative Services Division
Nonoccupational

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