(1) An application for a supplier’s license shall be filed with the department on a form prescribed by the department. The application shall include: (a) The name and address of the applicant. (b) A designation of the type of business organization of the applicant and the date and place of its original establishment. (c) The name and address of each officer, director, shareholder, partner, member or other person with an ownership interest in the applicant business. (d) A statement showing the gross receipts realized in the preceding year on the sale or distribution of bingo supplies and equipment to licensed organizations. (e) The name and address of any supplier of bingo supplies and equipment to the applicant. (f) The number of years the applicant has been in the business of supplying bingo supplies and equipment. (g) If the applicant business is organized outside of this state, the name and address of a resident agent who is authorized to be served legal documents and receive notices, orders and directives of the department. (2) (a) Each application for an initial supplier’s license or for a renewal thereof shall be accompanied by a fee of $25. (b) When the supplier’s license expires, the supplier shall pay a supplementary fee based on the supplier’s gross sales of bingo supplies and equipment to licensed organizations during the preceding year. The supplementary fee shall be determined in accordance with the following schedule: Amount of Gross Sales Fee Less than $5,000 $10 Between $5,000 and $19,999 $50 Between $20,000 and $49,999 $200 Between $50,000 and $100,000 $500 More than $100,000 $1,000 (c) All moneys received under this subsection shall be credited to the appropriation account under s. 20.505 (8) (jn).
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