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UH PTAC Application for Services


IMPORTANT NOTICE

This application should only be completed by the majority owner of the company.

You must be a registered business in the State of Texas with your principle place of business in one of our 35-county service areas to be eligible for our services.  Select the Service Area link above to see a list of our county service areas.

The majority owner can designate an employee to meet with a UH PTAC advisor without the majority owner present.  The Designated Representative must be a W2 employee of the business and cannot be 1099 Independent Contractors.  If you (majority owner) plan to assign a Designated Representative, provide the information required in the appropriate areas of the application below.


Required field *
Numbers only - no spaces, dashes or special characters.
Numbers only - no spaces, dashes or special characters.
Please provide data on the majority owner.
Please provide data on the majority owner.
Please provide data on the majority owner.
Please provide data on the majority owner.
Please provide data on the majority owner.
Please provide data on the majority owner.
Designated Representative must be a W-2 Employee - No 1099 Contractors
Numbers only - no spaces, dashes or special characters.
Numbers only - no spaces, dashes or special characters.
Provide the DBA Name if used
Numbers only - no spaces, dashes or special characters.
* Date Business Started / / (MM/DD/YYYY) Must be in business at least one year to qualify for the PTAC Program.
If you have a Dun and Bradstreet (DUNS) number please enter it here.
If you have a CAGE code, please enter it here.
*
*