Obtain License

You will need to choose one of the application packet(s) listed below. Every form in the packet that you choose must be submitted if it applies to your situation. Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.

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Application Packet for Wholesale Distributor Of Prescription Drugs

	Form #	Title
	2813	Instructions to Applicants For Licensure of a Wholesale Distributor
	2814	Application For Wholesale Distributor of Prescription Drug License
	2812	Designated Representative Form
	2552	Addendum to Application -Business Entities FEIN #
	2819	Bond of Prescription Drug Wholesale Distributor form (This form must be used, there are no exceptions or modifications to this form that will be approved.)
	2824	Irrevocable Letter of Credit of Prescription Drug Wholesale Distributor form (This form must be used, there are no exceptions or modifications to this form that will be approved.)
	2687	Authorization for Release of FBI Information form (This form is required for all designated representatives.)
	2823	Fingerprint Card Scan Authorization Form (This form is required if your designated representative is non VAWD accredited and  will be fingerprinted outside of Wisconsin.)
	2252	Convictions and Pending Charges  (if applies)
	1988	Notices (Department Information)

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ATTENTION 2008 Renewal Applicants:

The 2008 renewal notice that you received in the mail, in order to renew your license you must complete the entire application packet. This packet must be received and approved before you will be allowed to renew your WI license. Upon the expiration of your 5-31-08 renewal, you may not continue to conduct business in WI until the new application has been approved.

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Other Forms and Information

	Form #	Title
	2556	Business Models and Requirements for Licensure
	2821	Procedures for Reporting Theft or Loss of Controlled Substances
	DEA 106	DEA Form for Reporting Theft or Loss of Controlled Substances
	2691	Division of Enforcement Supplemental DEA Form for Reporting of Theft or Loss of Controlled Substances
	2822	Change in Designated Representative for Wholesale Distributor of  Prescription Drugs Form Complete and return this form and form #2687 (along with form # 2823 if applies) when a change occurs.

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