
To: Texas Department of State Health Services, RLU, Food & Drug Licensing, P.O. Box 12008, Austin, Texas 78711 For assistance in completing this application call (512) 834-6727 PSEUDO 2510 BUDGET: ZZ114 FUND 996 LICENSE # Name Under Which Business is Conducted (DBA): Physical Address to be Licensed: City, County, State, Zip Code: Telephone # at address: ( ) List of All Health Care Products, By Type, Sold At The Business Address Listed Above. Attach Additional Sheet If Necessary: Name(s), A.
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How to fill out the TX EF23-12957 online
Navigating the TX EF23-12957 form can be straightforward with the right guidance. This document serves as a comprehensive guide to help users complete the Minor Amendment License Application effectively and efficiently.
Follow the steps to complete the TX EF23-12957 form online.
- Click the 'Get Form' button to obtain the form and open it in the designated editor.
- Begin by entering the name under which the business is conducted (DBA) in the specified field.
- Fill in the physical address to be licensed, including city, county, state, and zip code.
- Provide the telephone number for the business address. Ensure it is accurate for future communication.
- List all health care products by type sold at the business address. Use additional sheets if necessary.
- Include the names, addresses, and contact persons of your wholesale distributors. Attach an additional sheet if needed.
- Indicate where products containing ephedrine, pseudoephedrine, or norpseudoephedrine will be stored. Choose either behind a sales counter or in a locked case within 30 feet of a staffed sales counter.
- Attach all required additional documentation, which includes a list of inventory of regulated products, a description of employee training, and written procedures for product storage.
- Select the purpose of the application and mark the appropriate box to indicate any changes in the status of your firm.
- Fill in the required details of the responsible individual in charge at the physical address.
- Complete the billing information section, including the name, address, and contact details of the application preparer.
- Review all sections to ensure accuracy and completeness before signing and dating the application.
- Save changes to your form, and download or print the completed application for submission.
Complete your TX EF23-12957 document online to ensure a smooth filing process.
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