Designation of Primary and Secondary Qualifying Agents (ECLB 5)
This form is to be used by individuals who already qualify the business and wish to change their designation from Primary Qualifier to Secondary Qualifier or Secondary Qualifier to Primary Qualifier. Do not use this application if you do not already qualify the business as either a primary or secondary qualifier.
FEE: No fee required.
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.
Application Currently Unavailable Using Online Services
Under Florida law, email addresses are public records. If you do not want your email address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail.
If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one.
The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public.