Bingo-Raffle Supplier's Agent Registration

Your registration must be filed and paid for online with a credit card or prepaid account.

Both the agent and the supplier or chief executive officer of the supplier must be present for the signing of this application.

If applicable, you must attach a detailed explanation of the facts and circumstances concerning any conviction for a felony, theft by deception, gambling-related offense within more than the previous ten years. This applies to owners, officers, directors, partners, members or associates.

Tips for attachments

You can attach .jpg, .gif, .png, or .tif image files, or PDF files.

Multiple files can be uploaded. Combined size of all files must be 4 MB or less. 1 MB = 1024 KB

If you need to attach documents, make sure they are ready before you continue.