Get A Permit Fee Of $200 Must Accompany This Application

This guide provides clear and comprehensive instructions for filling out the A Permit Fee of $200 Must Accompany This Application. By following these steps, users can ensure a smooth submission process and avoid common pitfalls.

Follow the steps to successfully complete your application online.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by entering your name and/or doing business as (DBA) along with the street address of your facility in the designated fields. Ensure that all information is clear and legible.
3. Complete the mailing address section. If you have a different mailing address, provide it here.
4. Review the change options. Mark the checkbox if there is a name change, ownership change, or address change that applies to your application.
5. Indicate the types of prescription items sold or shipped to Oklahoma by checking the appropriate boxes (Controlled or Non-Controlled).
6. Specify the type of permit requested from the options provided. Describe your business practices at this location by selecting all relevant checkboxes.
7. Enter the name and contact details of the facility manager, including their phone number and email address.
8. Indicate the type of ownership by checking the appropriate box (individual, partnership, or corporation).
9. Provide additional details regarding the state of incorporation and the name of the partnership or corporation if it differs from your facility name.
10. List the individuals responsible for your application, including owners and corporate officers. If necessary, attach a separate page.
11. Answer the questions regarding any arrests, charges, or disciplinary actions within the last 12 months. If yes, provide details on a separate page.
12. If your facility is located in another state, attach a copy of the respective license showing the license number and expiration date.
13. Complete the section with the name and title of the person responsible for the application. Ensure you provide a signature and the date.
14. Once all sections are thoroughly completed, review your information for accuracy. Save your changes, then download, print, or share the form as required.

Complete your application online to ensure timely processing and compliance with permit requirements.