TEXAS DEPARTMENT OF LICENSING AND REGULATION
PO Box 12157 Austin, Texas 78711-2157
(800) 803-9202
(512) 463-6599
FAX (512) 475-2871
www.tdlr.texas.gov
cs.cosmetologists@tdlr.texas.gov
cs.barbers@tdlr.texas.gov
DUAL BARBER SHOP/COSMETOLOGY SALON LICENSE APPLICATION INSTRUCTIONS
The application must be completed and signed by the applicant. An application is not considered complete and will not
be processed until all required items have been submitted. All information provided must be typed or printed in black
ink. Attachments must be submitted on separate pieces of single-sided, 8½” x 11” paper. Use a paperclip to fasten all
pages together, with a cashier’s check or money order on top. Do not use staples.
DOCUMENTS SUBMITTED WITH YOUR APPLICATION WILL NOT BE RETURNED. KEEP A COPY OF YOUR
COMPLETED APPLICATION, ALL ATTACHMENTS, AND YOUR CASHIER’S CHECK OR MONEY ORDER.
1. DUAL SHOP/SALON NAME - Write the name of your dual shop/salon as it should appear on your shop license.
(maximum of 40 characters)
2. PREVIOUS BARBER SHOP AND SALON LICENSE NUMBER - If applicable, write the license number of the barber
shop and cosmetology salon that will become a dual barber shop and cosmetology salon.
3. DUAL SHOP/SALON’S MAILING ADDRESS - Write your current business mailing address. This is the address
where we will send you mail. This address can be a post office box. You can add the zip plus-4 to help the postal
service deliver mail more efficiently and accurately. Always keep your mailing address current with TDLR. A license
renewal notice will be mailed to your address of record before the date your license will expire.
4. PHONE NUMBER - Write a telephone number, including the area code, where we can reach you or leave a mes-
sage for you during the day.
5. EMAIL ADDRESS - Write your email address. Please provide your email address so the department may email li-
cense information and required notices to you. Your email address is confidential pursuant to the Texas Public Infor-
mation Act, and the department will not share it with the public.
6. DUAL SHOP/SALON’S PHYSICAL ADDRESS - Write the physical address for your dual shop/salon. A post office
box cannot be used for this address. Once your license has been issued, you can only change the salon’s physical
address by applying for a new license.
7. FAX NUMBER - Write a fax number, including the area code, where we can send you faxes.
8. PHONE NUMBER - Write a telephone number, including the area code, where we can reach you or leave a mes-
sage for your during the day.
9. TYPE OF OWNERSHIP - Check the box that indicates how your business is organized. You can find a description of
the various types of business structures at www.sos.state.tx.us/corp/businessstructure.shtml
10. OWNER INFORMATION - Write the owner information of your business. If this business is a SOLE PROPRIETOR-
SHIP, write your name, social security number, and date of birth in the provided space. Also include your mailing
address and other requested information.
Social security number disclosure is required by Section 231.302(1) of the Texas Family Code in order to obtain a
license. Your social security number is subject to disclosure to an agency authorized to assist in the collection of
child support payments. For more information regarding child support payments, contact the Texas Attorney General
at: www.oag.state.tx.us/child/index or call (512) 460-6000 or (800) 252-8014.
See item 8 for information on email disclosure.
11. ADDITIONAL OWNERS INFORMATION - Write the additional owners’ information of all persons or entities that
owns at least 25 percent of this business. See item 10 for information on social security number disclosure and item
7 for information on email disclosure.
12. STATEMENT OF APPLICANT - Carefully read the statement before you date and sign your application.
State law prohibits renewing a license more than once after a licensee has defaulted on a student loan guaranteed by
the Texas Guaranteed Student Loan Corporation (TGSLC) unless the licensee has entered into a repayment agreement
with TGSLC. YOU SHOULD CONTACT TGSLC BEFORE FILING THIS APPLICATION if you have defaulted on a stu-
dent loan. An application or renewal may be rejected if this agency has received information from TGSLC that the appli-
cant has defaulted on a student loan. The Texas Guaranteed Student Loan Corporation can be contacted at: Texas
Guaranteed ATTN: Collections, PO Box 83100, Round Rock, TX 78683-3100, Telephone: (800) 222-6297,
http://
www.tgslc.org
or email: cust.assist@tgslc.org.
THIS APPLICATION IS FOR A FULL SERVICE BARBER SHOP AND COSMETOLOGY SALON ONLY.
SPECIALTY SHOPS ARE NOT ELIGIBLE FOR A DUAL LICENSE.
YOU MUST MEET ALL REQUIREMENTS WITHIN 12 MONTHS OF THE FILING DATE, OR THE APPLICATION WILL BE TERMINATED.
APPLICATION FEE: $130 (FEE IS NON-REFUNDABLE)
PAYMENTS MUST BE IN THE FORM OF A CASHIER’S CHECK OR MONEY ORDER PAYABLE TO TDLR
ALL INFORMATION MUST BE TYPED OR PRINTED IN BLACK INK
1. Dual Shop/Salon Name:
_______________________________________________________________________________________________
3. Dual Shop/Salon’s Mailing Address:
(USED TO RECEIVE MAIL FROM TDLR) (A PO box is allowed for this address.)
Number, Street Name, Suite Number/Apartment Number
________________________________________________________________________________________________________________________________________________________________
City State Zip Code
6. Dual Shop/Salon’s Physical Address:
(A PO box is not allowed for this address.)
Number, Street Name, Suite Number
________________________________________________________________________________________________________________________________________________________________
City State Zip Code
Sole Proprietorship
* Corporation
* Limited Liability Company
General Partnership
* Limited Liability Partnership
* Limited Partnership
9. Type of Ownership:
7. Fax Number:
(_______________) ____________________________________________________
Area Code Phone Number
DUAL BARBER SHOP/COSMETOLOGY SALON LICENSE APPLICATION
PO Box 12157
Austin, Texas 78711-2157
(800) 803-9202
(512) 463-6599
FAX (512) 475-2871
www.tdlr.texas.gov
cs.cosmetologists@tdlr.texas.gov
cs.barbers@tdlr.texas.gov
2. Previous Barber Shop Permit Number: ___________ Previous Cosmetology Salon License Number__________
(if applicable) (if applicable)
4. Phone Number:
(_______________) ____________________________________________________
Area Code Phone Number
5. Email Address:
_______________________________________________________________________________________
(Ex: johndoe@aol.com) See instruction sheet for disclosure information
8. Phone Number:
(_______________) ____________________________________________________
Area Code Phone Number
TDLR Form COS012 rev February 2017
Page 1 of 2
* Must provide a Federal Tax ID number in item 10.