Notice of Intent to Operate a Remote Service Business

Fill out this form if you do not hold a Barber or Cosmetologist license.

Remote Service Business Name and Start Date of Service

Business name*

Date the business will begin offering digitally prearranged remote services

Begin date*

Contact Information

Select services provided*

Street address*

City*

Zip code*

Phone number*

Email address*

Name of Digital Network Company

Digital company name*

Street address*

City*

Zip code*

Business entity type*

Other information such as the name of other owner(s), contact information for other owner(s), etc.

By submitting this web form, I certify that I will comply with the requirements of Texas Occupations Code, Chapters 1601, 1602, and 1603, 16 Texas Administrative Code, Chapters 82 and 83, and all health and safety requirements related to my licensed occupation or profession. I further certify that all information I have provided is true and correct. I understand that providing false information may result in revocation of my license.

Attachments (BMP, DOC, DOCX, GIF, JPEG, JPG, PDF, PNG, TIFF, XLS, XLSX)

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