| (a) License application forms. License application
forms may be obtained from the Texas Department of State Health Services,
1100 West 49th Street, Austin, Texas, 78756, or online at www.dshs.texas.gov.
(b) Contents of license application. The application
for licensure as a wholesale distributor of nonprescription drugs
must be signed and verified, submitted on a license application form
furnished by the department, and contain the following information:
(1) the name of the legal entity to be licensed, including
the name under which the business is conducted;
(2) the address of each place of business to be licensed;
(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 corporation
charter number; or if any other type of association, the names of
the principals of such association;
(4) the name and valid driver license number for each
individual in an actual administrative capacity which, in the case
of proprietorship, must 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) for each place of business, the residence address
of the individual in charge;
(6) a list of categories which must be marked and adhered
to in the determination and payment of the fee as described in §229.249
of this subchapter (relating to Licensure Fees); and
(7) a statement verified by the applicant's signature
acknowledging the applicant read, understood, and agrees to abide
by the provisions of this subchapter and those of the Act.
(c) Renewal license application. The renewal application
for licensure as a wholesale distributor of nonprescription drugs
must be made on a license application form furnished by the department.
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