OTB Qwik Bet Questionnaire
SUFFOLK REGIONAL OFF-TRACK BETTING CORPORATION
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In order for Suffolk Regional Off-Track Betting Corporation to determine if “Qwik Bet”
may be located in your business, you must fill out this form completely.

Do NOT leave any portion of the questionnaire blank.

Name of Establishment:
Date:
D/B/A:
Business Address:
Business Phone:
Name(s) of Owner(s):
Primary Contact Person:
Best Time to be Reached:
Phone / Cell No.:
Email:
Website:

Seating Capacity:
Fire Code Capacity
(if different):
Number of on-site
Parking Spaces:
Is there any municipal/public
parking nearby?:
Yes No
Hours of Operation:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Number of Employees:
Is there a manger on duty
at all times?:
Yes No
Number of Televisions:
Do you have a
cable/satellite provider?:
Yes No
Do you have NYS Lottery/Quick Draw?:
Yes No
What is your proximity to
the nearest educational institution:
What is your proximity to
the nearest place of worship:
What is your proximity to
the nearest residence:

The New York State Racing and Wagering Board and Suffolk Regional Off-Track Betting Corporation require an in depth background investigation regarding both personal and company finances (including tax returns).

Would you agree to such an investigation?
Yes No

Please use the following space to describe your establishment to us. Provide us with any additional information you feel may help Suffolk Regional Off-Track Betting in determining whether “Qwik Bet” is suitable for your location. Please include a description of the type of establishment (eg: sports bar, “neighborhood” bar, food and drink) and your clientele (age ranges). You may attach pictures and/or diagrams of your establishment.