Form No. Pa-400 - Instructions For Application For Pesticide Applicator License (Page 3 of 3) in pdf

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

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

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