This form is to be used by business entities with multiple qualifiers to designate qualifiers as primary or secondary.
Application Requirements:
FEE:Pay the required fee as provided in the application.Make check payable to the Department of Business and Professional Regulation.
APPLICATION:Complete the application by clicking on the "Printable Application" link at the bottom of the page.
If you have questions or need assistance in completing this application, please call the Customer Contact Center at 850.487.1395 or use our convenient contact form.
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