1004 9
th
Avenue North, Texas City, TX 77590-7407
www.texas-city-tx.org (409) 948-2525
All payments must be made by check, cashiers check or money order.
TEXAS CITY POLICE DEPARTMENT
Name of Applicant:
Date of Birth:
Address:
TXDL#:
Telephone No.
Business Name of Vending Company:
Address of Vending Company:
Telephone Number(s) of Vending Company:
State Vending Permit Number of License:
List all Coin Operated Machines that are to be used on the premises:
(Additional pages may be added)
Type of Machine
(Example: pool table, jukebox…etc)
Make
Serial Number
Signature: _______________________________________________ Date: ______________________
$15 per Machine
Occupational Tax
FRAUDULENT / FALSE INFORMATION WILL RESULT IN IMMEDIATE DISQUALIFICATION
(Illegible and/or incomplete applications will be denied)
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