No Form Number Application & Certification Citrus By-Products Purchase

OMB No. 0581-0189

TEXAS VALLEY CITRUS COMMITTEE
901 Business Park Drive, Suite 400
Mission, Texas 78572
Telephone: (956) 581-2190
Fax: (956) 584-3307
APPLICATION & CERTIFICATION
CITRUS BY-PRODUCTS PURCHASE AGREEMENT
Firm: ___________________________________________________ Phone No.: ___________________________
Mailing Address: _______________________________________________________________________________
(Address, City, State, Zip Code)

Physical Address: _____________________________________________ Fax No.: _________________________
(If Different Than Mailing Address)

Our firm, which is engaged in the manufacture of citrus products, hereby requests that the Texas Valley
Citrus Committee (the “Committee”) approve this application for eligibility under sections 906.34 and 906.40 of
Marketing Order No. 906.
In submitting this application, the undersigned organization understands that all the Texas citrus our firm
receives that is exempt from regulations must be used solely for the processing of juice products. We agree:
1. that citrus received for processing will under no circumstances enter into fresh fruit marketing channels;
2. not to sell or transfer for sale, directly or indirectly, any fruit from Texas for processing;
3. to maintain our PACA license during the period when buying fruit from Texas;
4. to undergo random inspection by the Committee or by a designated State/Federal Agency;
5. to not have facilities, equipment, or outlets to repack or sell fruit in its fresh form;
6. to report on the “Orange and Grapefruit Diversion Report” provided by the Handler from whom the fruit is
purchased, the actual weight of the fruit, by attaching the scale ticket at the point of receiving to the proper
copy of the Diversion Report. This shall be returned to the Committee within the week; and
7. that failure to comply with the terms of this Agreement, will cause removal of our name from the list of
certified processors.
This Agreement, when signed by an authorized agent and returned to the Committee, will serve as
certification of a receiver of Texas citrus for processing into juice products.
By: ___________________________________________
Signature of Processor
______________________________________________
Name (please print)

_____________________________
Date
_____________________________
Title

Person Responsible for Orange & Grapefruit Diversion Report: __________________________________________
NO SHIPMENTS OF SPECIAL PURPOSE ORANGES OR GRAPEFRUIT MAY BE MADE UNTIL THIS
FORM HAS BEEN APPROVED BY THE COMMITTEE.
Approved by: ____________________________________________
Texas Valley Citrus Committee

____________________
Date

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The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin,
age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political
beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (not all prohibited bases apply to
all programs). Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape,
etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C.
20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Rev. 7/12. Destroy previous editions.