Applying for (Check one):           Gaming License     Non-Gaming License Check one: New Vendor License  Renew Vendor License   Fields inside the box are REQUIRED.
Company Name:			Today's Date
Aliases:			Contact Name
Street Address:			Telephone
Suite:			FAX
City:			E-mail
State:	AK AL AR AZ CA CO CT DE FL GA 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 RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NF NS SK NT NU ON PE QC YT
Zip Code:			Tax ID #:
Type of business (check all that apply):	Sole Proprietorship Corporation Partnership Other			List officers or partners:         First Name            Middle             Last Name 1. 2. 3. 4. 5.
			List other casinos with which you do business:
Treasure Island Resort & Casino contact:  Name: Phone #:			Volume of business:	Over $25,000     Under $25,000