Form SPC-402 "Structural Pest Control Services Noncommercial Employer Registration" - Texas

What Is Form SPC-402?

This is a legal form that was released by the Texas Department of Agriculture - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 15, 2018;
  • The latest edition provided by the Texas Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SPC-402 by clicking the link below or browse more documents and templates provided by the Texas Department of Agriculture.

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Download Form SPC-402 "Structural Pest Control Services Noncommercial Employer Registration" - Texas

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(877) 542-2474
(512) 463-7476
Hearing impaired: (800) 735-2988 voice
(800) 735-2989 (TTY)
www.TexasAgriculture.gov
Texas Department of Agriculture
SPC-402
Structural Pest Control Services
Noncommercial Employer Registration
1
BUSINESS TYPE
TDA USE ONLY
Noncommercial
School
Client No.
Account No.
Noncommercial Political
Date (mm/dd/yy)
Initials
2
APPLICANT INFORMATION
Full legal business name (owner’s name if sole proprietor – no aliases)
D.B.A. (if applicable)
Comptroller Taxpayer ID No. (required for in-state businesses)
Is this a temporary ID?
Yes
No
Federal Taxpayer ID No. (out-of-state businesses only)
Social Security No. (Sole Proprietor only)
-
-
1
RESPONSIBLE PERSON INSTRUCTIONS
Please list the full legal name (no aliases or nicknames) of the primary individual responsible for management and
oversight of the business, as indicated:
For a corporation, limited liability company, cooperative, or other type of entity: the president, CEO, or
manager (or similar function with title),
For a limited or general partnership: the managing partner (or similar function with title),
For a sole proprietorship: the owner,
2
RESPONSIBLE OFFICER, PARTNER, MANAGER, OR OWNER
For any other type of business, the general manager.
Mr.
Mrs.
First Name
M. I.
Last Name
Ms.
Phone No.
E-mail
(
)
-
Ext.
3
RESPONSIBLE PERSON MAILING ADDRESS
Address
City
State
Zip
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 552.021, 552.023, and 559.004.)
Structural Pest Control Services Business Application
Revised 05/15/18
Pesticide
(877) 542-2474
(512) 463-7476
Hearing impaired: (800) 735-2988 voice
(800) 735-2989 (TTY)
www.TexasAgriculture.gov
Texas Department of Agriculture
SPC-402
Structural Pest Control Services
Noncommercial Employer Registration
1
BUSINESS TYPE
TDA USE ONLY
Noncommercial
School
Client No.
Account No.
Noncommercial Political
Date (mm/dd/yy)
Initials
2
APPLICANT INFORMATION
Full legal business name (owner’s name if sole proprietor – no aliases)
D.B.A. (if applicable)
Comptroller Taxpayer ID No. (required for in-state businesses)
Is this a temporary ID?
Yes
No
Federal Taxpayer ID No. (out-of-state businesses only)
Social Security No. (Sole Proprietor only)
-
-
1
RESPONSIBLE PERSON INSTRUCTIONS
Please list the full legal name (no aliases or nicknames) of the primary individual responsible for management and
oversight of the business, as indicated:
For a corporation, limited liability company, cooperative, or other type of entity: the president, CEO, or
manager (or similar function with title),
For a limited or general partnership: the managing partner (or similar function with title),
For a sole proprietorship: the owner,
2
RESPONSIBLE OFFICER, PARTNER, MANAGER, OR OWNER
For any other type of business, the general manager.
Mr.
Mrs.
First Name
M. I.
Last Name
Ms.
Phone No.
E-mail
(
)
-
Ext.
3
RESPONSIBLE PERSON MAILING ADDRESS
Address
City
State
Zip
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 552.021, 552.023, and 559.004.)
Structural Pest Control Services Business Application
Revised 05/15/18
Pesticide
Structural Pest Control Services Non-Commercial Registration
Page 2 of 3
1
PERSON TO CONTACT FOR LICENSE-RELATED MATTERS
Mr.
Mrs.
First Name
M. I.
Last Name
Ms.
___
Title
Primary Phone
(
)
-
Ext.
Secondary Phone (optional)
Fax (optional)
(
)
-
Ext.
(
)
-
Ext.
E-mail
2
MAILING ADDRESS
Address
City
State
Zip
County
1
FACILITY INFORMATION
Facility Name
2
PHYSICAL ADDRESS OF FACILITY
Address (No P.O. Box)
City
State
Zip
County
Directions to physical address if above location is difficult to find
1
RESPONSIBLE CERTIFIED APPLICATOR INFORMATION
TDA License No.
Printed Name of Responsible Certified Applicator (required if
Apprentices/Technicians will be registered)
Signature of Responsible Certified Applicator
LICENSE FEE FOR BUSINESS
Total Number of Apprentices ____@$125.00 EACH
Attach the applications of all apprentices to this application. Business must have at least one Certified
$____
Applicator to be designated responsible before any Apprentices/Technicians may be registered.
Total Remitted
$____
Structural Pest Control Services Non-Commercial Registration
Revised 05/15/18
Structural Pest Control Services Non-Commercial Registration
Page 3 of 3
You must complete ALL licensing activity within one year of the application date. An incomplete
application shall become void on the one-year anniversary of submission. A void application will not be
processed. SPCS application fees are non-refundable.
1
SIGNATURE
The applicant, by and through their signature below, or the signature of a duly authorized agent certify and
acknowledge that: (1) all information provided in this application is true and correct; (2) any misrepresentation or
false statement made in connection with this application, whether intentional or not, will constitute grounds for
denial, revocation, or non-renewal of any license requested or issued as a result of this application, and/or
assessment of monetary administrative penalties; and (3) if applying as an individual, that this application may be
denied and any license requested or issued as a result of this application may be suspended, revoked, or denied due
to delinquency in payment of a guaranteed student loan or for failure to pay child support. If signed by an agent
(including employee) of the applicant, the person signing certifies that he or she is authorized to make the preceding
certifications on behalf of the applicant.
Applicant Name (print)
Title
Applicant Signature
Date (mm/dd/yyyy)
/
/
Mail to:
Texas Department of Agriculture
P.O. Box 12076
Austin, TX 78711-2076
Additional items that may be required to be sent to the SPCS in order to complete the application process:
*noncommercial only* - request your insurance agent to forward a current and
complete certificate of insurance coverage to TDA. The form ALS-1101 may be obtained from the SPCS website
click on the link to "forms." All information on the ALS-1101 MUST match the business registration exactly.
Any employees engaged in pest control services must be registered with a business entity.
Structural Pest Control Services Non-Commercial Registration
Revised 05/15/18
Page of 3