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Charitable Games Applications
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Other Required Documents
Upon completion of the following form click the submit button,
you will then be able to download the appropriate application
as a .pdf document.
I would like to meet with a Charitable Games Representative
I would like to have an information seminar
I would like to have information mailed
Organization Information
*
Organization Name:
*
Phone Number:
*
Address 1:
Address 2:
*
City:
*
State:
(Please Select)
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip:
Tax Exempt Status
Contributions to our organization are tax deductible by Donors
Contact Person's Information
*
Contact Person's First Name:
*
Contact Person's Last Name:
*
Phone Number:
If YOUR mailing address differs from the Organization's address enter it here
Address 1:
Address 2:
City:
State:
(Please Select)
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip:
Email Address:
Which type of Charitable Gaming License are you interested in?
*
Check all that apply
Bingo - Regular
Bingo - Recreational (Seniors)
Bingo - Multi-Hall
Bingo – D.C Government
Raffle
Monte Carlo Night Party/Texas Hold'em'
Supplier