GO TEXAN Partner Application

GO TEXAN Registrant Application

Texas Department of Agriculture
Registration Level *
prevnext( X )
Tier I
Use of the widely recognized GO TEXAN certification mark, listing on GO TEXAN websites and mobile apps, opportunities to be featured on GO TEXAN social media, discounted rates for advertising and events.

$100.00



Tier II
Tier I benefits, plus your business name in relevant directories, eligibility to apply for grants, priority registration for events.

$500.00



Tier III
Tier II benefits, plus your business name listed in printed directories, your company logo on the GO TEXAN website.

$1,000.00



Champion Sponsor
Tier III benefits, plus prominent placement of your company logo on GO TEXAN homepage and customized GO TEXAN benefits.

$5,000.00



Total

$0.00
PRODUCTASSOCIATE
List all products you wish to certify GO TEXAN.*
Please provide general product types in a list format. Do not use complete sentences. Please use a semicolon to separate each product (snacks; jerky; water; etc)
YesNo
LivestockFarm/CropsOrchard/GroveVineyard
Commodity GroupCommodity Producer BoardCommunity OrganizationCooperative OrganizationDistributor of GO TEXAN or Texas ProductsFarmers MarketFestival/Rodeo/FairLandscape Contractor Using Texas ProductsLandscape Designer Using Texas ProductsLandscape Maintenance Using Texas ProductsRetailerState Agency or BoardTrade AssociationFarm/RanchProducer GrowerManufacturerProcessorDesignerMillPrivate Label MarketerNon Ag Marketing EntityRestaurantFloristCo-PackerOther
Chamber of CommerceCityCountyEconomic DevelopmentVisitor BureauOther
Furniture StoreGarden Center/Retail NurseryGeneral Store/Feed StoreGrocery StoreInternet StoreMass MerchandiserSpecialty BoutiqueSpecialty/Gourmet ShopSpecialty Department StoreTrade Show RetailerWildlife ProductsWine/Package Store
CooperativeCorporationGeneral PartnershipLimited Liability Co.Limited PartnershipSole ProprietorshipOther
Applicant Information
Full Legal Business Name (Owner's name if sole proprietor - No aliases)*
D.B.A. (if applicable)
Applicant Identification Number
YesNo
What is your Texas Driver's License Number?*
YesNo
Sales and Use Tax or Taxpayer Vendor ID Number*
Must be 11 digits
YesNo
What is your Federal Taxpayer Identification Number?*
Employee Identification Number (EIN) will NOT be accepted.
YesNo
Responsible Officer, Partner, Manager or Owner

Please list the full legal name (no aliases or nicknames) of the primary person responsible for the business; for example: president, managing partner, general manager or owner.
Name*

PrefixFirst NameMiddle InitialLast NameSuffix
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County
Person to Contact for GO TEXAN Related Matters
Same as AboveI want to add a different contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Email
Please provide additional email address to receive GO TEXAN (only) information
Facility Information

Must provide the physical street address of the business; use EMS address for Rural Routes. If you are an out-of-state company, provide Texas address where product is made or service is provided.
Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
YesNo
Please provide directions to physical location if it is difficult to find.
Company Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Company Email*
example@example.com
YesNo
Facebook Handle
Twitter Handle
Instagram Handle
Website
Gross receipts under $1 million and fewer than 50 full-time employeesGross receipts over $1 million and fewer than 50 full-time employeesGross receipts under $1 million and more than 50 full-time employeesGross receipts over $1 million and more than 50 full-time employees
Co-packerDesignerManufacturerMillPrivate LabelerPrivate Label Marketer (product is produced/processed for you by a private labeler)ProcessorProducer/Grower
Brand Names
If applicable, please list the brand name(s) used to market your products.
Direct to PublicDirect to RetailersDirect to WholesaleFood ServiceGourmet MarketInternetMail OrderOut-of-State
Yes, I currently export my productNo, but I'm interestedNo
Terms and Conditions
1. Applicant is in good standing and qualified to do business in this state;
2. Applicant is in compliance with all applicable laws and regulations pertaining to the selling, advertising, marketing, packaging, manufacturing or commercial handling of its products and/or services;
3. Failure to comply with GO TEXAN program rules as set out in the Texas Administrative Code, Title 4, Part 1, Chapter 17, Subchapter C, may result in termination of GO TEXAN membership without refund of fees paid;
4. Texas Department of Agriculture (TDA) has sole discretion to determine if Applicant is eligible for participation in the GO TEXAN program;
5. TDA has sole discretion to determine if the actions of Applicant, its employees and agents, meet GO TEXAN program requirements;
6. TDA has permission to use any image, depiction, photograph, display provided to it, or name of Applicant, or its principals, officers, employees, and/or products, in the promotion of the GO TEXAN program, in any media format or type;
7. Applicant agrees to indemnify and hold TDA harmless from any and all claims, demands, damages (including reasonable attorney’s fees) and causes of action arising out of or relating to the use referred to in section (f) above;
8. All information provided in this application is true and correct;
9. Any misrepresentation or false statement made in or as part of this application, whether intentional or not, will constitute grounds for denial of the application, or termination of privileges of the GO TEXAN program;
10. Applicant is not delinquent in payment of any guaranteed student loan or child support obligation;
11. The GO TEXAN certification mark must be used in strict accordance with TDA’s rules and guidelines;
12. Applicant possesses all required, valid permits for its operations, including, without limitation, health permits, food establishment permits and manufacturing permits;
13. Applicant is not currently the subject of any enforcement actions or investigations by any federal, local or state authority, and no injunctions, fines or license revocations are pending against Applicant or its operations; and
14. The individual signing this application is authorized to make the preceding acknowledgements and certifications on behalf of Applicant.
Applicant Name*

First NameLast Name
Applicant Title*
Applicant Signature*
Date*

MonthDayYear
Date
Should be Empty:

GO TEXAN Registrant Application

Applicant Information

Applicant Identification Number

Responsible Officer, Partner, Manager or Owner

Person to Contact for GO TEXAN Related Matters

Facility Information