1. (a) License application forms. License application forms may be obtained from the Texas Department of Health, Drugs and Medical Devices Division, 1100 West 49th Street, Austin, Texas 78756.

2. (b) License application. The device distributor or manufacturer license application shall be signed and verified, shall be made on a license application form furnished by the Texas Department of Health (department), and shall contain the following information:

   1. (1) the legal name under which the business is conducted;
   2. (2) the address of each place of business that is licensed;
   3. (3) if a proprietorship, the name and residence address of the proprietor; if a partnership, the names and residence addresses of all partners; if a corporation, the date and place of incorporation and name and address of its registered agent in the state and a copy of the Articles of Incorporation; or if any other type of association, then the names of the principals of such association;
   4. (4) the name, residence address, and valid driver license number for each individual in an actual administrative capacity which, in the case of proprietorship, shall be the managing proprietor; partnership, the managing partner; corporation, the officers and directors; or those in a managerial capacity in any other type of association;
   5. (5) for each place of business, the residence address of the individual in charge thereof;
   6. (6) a list of categories which must be marked and adhered to in the determination and payment of the fee; and
   7. (7) a statement verified by the applicant's signature that acknowledges the applicant has read, understood, and agrees to abide by the provisions of these sections and those of the Texas Food, Drug, and Cosmetic Act, Health and Safety Code, Chapter 431.

Source Note:The provisions of this §229.436 adopted to be effective October 18, 1994, 19 TexReg 7910; amended to be effective March 19, 1996, 21 TexReg 1887.