GO TEXAN Registrant Application
Texas Department of Agriculture
Registration Level
*
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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
Registration Category (Select One)
*
PRODUCT
ASSOCIATE
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)
Are you producing farm/ranch products?
*
Yes
No
What types of farm/ranch products are you selling (check all that apply)?
*
Livestock
Farm/Crops
Orchard/Grove
Vineyard
What type of Business are you?
*
Commodity Group
Commodity Producer Board
Community Organization
Cooperative Organization
Distributor of GO TEXAN or Texas Products
Farmers Market
Festival/Rodeo/Fair
Landscape Contractor Using Texas Products
Landscape Designer Using Texas Products
Landscape Maintenance Using Texas Products
Retailer
State Agency or Board
Trade Association
Farm/Ranch
Producer Grower
Manufacturer
Processor
Designer
Mill
Private Label Marketer
Non Ag Marketing Entity
Restaurant
Florist
Co-Packer
Other
What type of community organization are you?
*
Chamber of Commerce
City
County
Economic Development
Visitor Bureau
Other
What type of Retailer?
*
Furniture Store
Garden Center/Retail Nursery
General Store/Feed Store
Grocery Store
Internet Store
Mass Merchandiser
Specialty Boutique
Specialty/Gourmet Shop
Specialty Department Store
Trade Show Retailer
Wildlife Products
Wine/Package Store
Business Type
*
Cooperative
Corporation
General Partnership
Limited Liability Co.
Limited Partnership
Sole Proprietorship
Other
Applicant Information
Full Legal Business Name (Owner's name if sole proprietor - No aliases)
*
D.B.A. (if applicable)
Applicant Identification Number
Are you a sole proprietor?
*
Yes
No
What is your Texas Driver's License Number?
*
Do you have a register Sales and Use Tax ID or Taxpayer Vendor ID#
*
Yes
No
Sales and Use Tax or Taxpayer Vendor ID Number
*
Must be 11 digits
Is this number temporary?
*
Yes
No
What is your Federal Taxpayer Identification Number?
*
Employee Identification Number (EIN) will NOT be accepted.
Have you been a GO TEXAN Partner previously?
*
Yes
No
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
*
Prefix
First Name
Middle Initial
Last Name
Suffix
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
County
Person to Contact for GO TEXAN Related Matters
Who is the best person to contact for all GO TEXAN related matters?
*
Same as Above
I want to add a different contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / 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
City
State / Province
Postal / Zip Code
Display this physical address on GO TEXAN website with company information?
*
Yes
No
Is this a retail location?
*
Yes
No
Please provide directions to physical location if it is difficult to find.
Company Phone
*
Please enter a valid phone number.
Company Email
*
example@example.com
Display this email address on GO TEXAN website with company information?
*
Yes
No
Facebook Handle
Twitter Handle
Instagram Handle
Website
Business Description
*
Gross receipts under $1 million and fewer than 50 full-time employees
Gross receipts over $1 million and fewer than 50 full-time employees
Gross receipts under $1 million and more than 50 full-time employees
Gross receipts over $1 million and more than 50 full-time employees
Business Category
*
Co-packer
Designer
Manufacturer
Mill
Private Labeler
Private Label Marketer (product is produced/processed for you by a private labeler)
Processor
Producer/Grower
Brand Names
If applicable, please list the brand name(s) used to market your products.
How products are sold:
*
Direct to Public
Direct to Retailers
Direct to Wholesale
Food Service
Gourmet Market
Internet
Mail Order
Out-of-State
Do you export?
*
Yes, I currently export my product
No, but I'm interested
No
Terms and Conditions
Applicant is in good standing and qualified to do business in this state;
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;
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;
Texas Department of Agriculture (TDA) has sole discretion to determine if Applicant is eligible for participation in the GO TEXAN program;
TDA has sole discretion to determine if the actions of Applicant, its employees and agents, meet GO TEXAN program requirements;
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;
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;
All information provided in this application is true and correct;
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;
Applicant is not delinquent in payment of any guaranteed student loan or child support obligation;
The GO TEXAN certification mark must be used in strict accordance with TDA’s rules and guidelines;
Applicant possesses all required, valid permits for its operations, including, without limitation, health permits, food establishment permits and manufacturing permits;
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
The individual signing this application is authorized to make the preceding acknowledgements and certifications on behalf of Applicant.
Applicant Name
*
First Name
Last Name
Applicant Title
*
Applicant Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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