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IGC > Supplier Licensing > Supplier Licensing Inquiry Form Supplier Licensing Inquiry Form

Fill out this form to inquire about Supplier Licensing

Name of Company:

Name of primary Contact Person:

Address:

City:

State:

Daytime telephone number:

Your Email:

Provide a detailed description of the goods or services that you intend to provide to Indiana casinos::

What is the full range of goods and/or services that your company offers?:

With which Indiana casinos do you have existing contracts or agreements in place to supply your goods or services?:

Section 1

Will your company or any affiliate manage gaming operations for an Indiana casino?
YesNo

Does your company or any affiliate manufacture any of the following: electronic gaming devices, chips, tokens, cards, dice, roulette wheels, keno balls, keno ball or number selection devices, shuffling devices, or TITO printers/ redemption machines?
YesNo

Does your company or any affiliate distribute any of the following: electronic gaming devices, chips, tokens, cards, dice, roulette wheels, keno balls, keno ball or number selection devices, or shuffling devices, or TITO printers/ redemption machines?
YesNo

Does your company or any affiliate provide gaming equipment maintenance or repair?
YesNo

Does your company or any affiliate provide security services, security systems, or surveillance systems?
YesNo

Does your company or any affiliate lease riverboats or dock facilities, or both?
YesNo

Will your company or any affiliate supply goods or services to a casino where your payment is calculated on a percentage of the casino gambling operation’s revenues?
YesNo

Does your company or any affiliate manufacture or distribute any equipment, mechanical, electromechanical, or electronic contrivance, component, or machine used remotely or directly in connection with gaming; any game that would not otherwise be classified as a gaming device, including, but not limited to, links that connect to progressive electronic gaming devices; computerized systems that monitor electronic gaming devices; equipment that affects the proper reporting of gross revenue; devices for weighing and counting money; or patron counting systems?
YesNo

Section 2

Does your company or any affiliate have a firm agreement, letter of intent, contract, or other assurance from an Indiana casino that the casino will purchase goods or services from you?
YesNo

Does your company or any affiliate manufacture, distribute, supply, repair, consult with, or provide any other goods or services that are directly related to casino gambling?
YesNo

Will your company or any affiliate supply any good and/or service to an Indiana casino that is not directly related to the gambling aspects of the casino operation?
YesNo

Section 3

Has your company or a predecessor or affiliate company ever held a gaming supplier license or equivalent in Indiana or any other jurisdiction?
YesNo

If yes, list jurisdictions :

Has your company or a predecessor or affiliate company ever withdrawn a gaming supplier license or application in Indiana or any other jurisdiction?
YesNo

If yes, list jurisdictions :

Has your company or a predecessor or affiliate company had a gaming supplier license denied, revoked, or not renewed in Indiana or any other jurisdiction?
YesNo

If yes, list jurisdictions and whether denied, revoked, or not renewed :

Does your company or any affiliate currently have a business relationship with a company that holds or is applying for an Indiana supplier license?
YesNo

If yes, list companies :

Does your company or any affiliate currently do business with an Indiana casino?
YesNo

If yes, list casino(s) :

Section 4

Is your company or any affiliate a junketeer or junket operator, or both?
JunketeerJunket OperatorBothNeither

 

Click Submit to send via E-mail to Indiana Gaming Commission Legal Division.