Pa-406 - Texas Department Of Agriculture - Pesticide Applicator Change Of Information
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2P.O. Box 12847 Austin, Texas 78711
(877) 542-2474
(512) 463-7476
Hearing impaired: (800) 735-2988 voice
Texas Department Of Agriculture
PA-406
Pesticide Applicator Change of Information
COM M ISSIONER SID M ILLER
1
VERIFICATION INFORMATION
Applicator Name
TDA Client No.
TDA License No.
Please provide ONLY the information that has changed.
1
NEW PHYSICAL ADDRESS
Address
County
City
State
Zip
Directions to Physical Location if address above is difficult to find
2
NEW MAILING ADDRESS
Same as Physical Address
Address
City
State
Zip
3
NEW CONTACT INFORMATION
Primary Phone
Secondary Phone (optional)
Fax (optional)
(
)
-
(
)
-
(
)
-
E-mail Address
***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me
informed of critical information, including licensing and regulatory updates; renewal invoices; and other important
communications. Failure to provide an email address may result in my not receiving time-sensitive information that could
affect my compliance with state regulations, thereby, resulting in monetary penalties.
This form can be emailed to
license.inquiry@TexasAgriculture.gov
or faxed to 800-909-8534.
This application becomes public record and is subject to disclosure. With few exceptions, you have the right to request
and be informed about the information that the State of Texas collects about you. You are entitled to receive and
review the information upon request. You also have the right to ask the state agency to correct any information that is
determined to be incorrect. (Reference: Government Code, Sections 522.021, 522.023, and 559.004.)
Licensing Department
Revised 1/1/15
Administrative Services Division
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