No Form Number 906- TX Citrus-Handler Application

OMB No. 0581-0189

TEXAS VALLEY CITRUS COMMITTEE Telephone: (956) 581-2190

901 Business Park Drive, Suite 400 Fax: (956) 584-3307

Mission, Texas 78572

HANDLER APPLICATION

20___ - 20___ SEASON

In accordance with Marketing Order No. 906, a handler is considered to be any person (except a common or contract carrier of fruit owned by another person) who handles fruit or causes fruit to be handled. If you handle oranges or grapefruit in the South Texas Counties of Cameron, Hidalgo, or Willacy, you must register as a handler with the Texas Valley Citrus Committee (Committee), by completing this form and returning it to the Committee at the address above.

□ Independent Handler □ Co-Op Handler

Firm Name ____________________________________________ Date _____________________

Tax Id No. _______________________ or Social Security No. _______________________

Mailing Address

(Address, City, State, Zip Code)

Physical Address

(Address, City, State, Zip Code)

Sales Phone No. ________________ Office Phone No. ________________ Fax No. ________________

Applicant Signature

Title

Sales Staff

List Brand Names or Labels:

Will you be individually labeling your product?

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is OMB 0581-0189. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

Rev. 9/2016. Destroy previous editions.