CCW White Glove Registration Form

Please fill out the White Glove Registration Form Below. Which may take about 30 minutes of your time.

You may save your progress by scrolling to the bottom of the form and clicking “Save and Resume Later”.

Our CCW experts will review this form when it’s submitted. They will either be contacting you for more information or to schedule your CCW White Glove appointment. 

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Legal Full Name
Legal Residence
Click or drag a file to this area to upload.
Must be dated within the last 60 days.
Must have 2 DIFFERENT forms
Generally accepted proof of residency:
Rent, Lease, or Mortgage Agreement
Credit Card Statement
Utility Bill
* If any of the above is in spouse's name, will accept with copy of marriage certificate
Click or drag a file to this area to upload.
Must be dated within the last 60 days.
Must have 2 DIFFERENT forms
Generally accepted proof of residency:
Rent, Lease, or Mortgage Agreement
Credit Card Statement
Utility Bill
* If any of the above is in spouse's name, will accept with copy of marriage certificate
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Use a white background. Do not wear sunglasses or a hat.

Please add 3 references below.

References must include your spouse AND cohabitants if applicable to you. If you are single or live alone, please include neighbors and people who you interact with the most as references.

Name (Character Reference #1)
Address of Character Reference #1
Name (Character Reference #2)
Address of Character Reference #2
Name (Character Reference #3)
Address of Character Reference #3
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Business Address
Click or drag a file to this area to upload.
List ANY license to carry a concealed weapon you have or were issued (Including any CCW from any state in the US)? Provide issuing agency name, issue date, CCW License #. Write N/A if not applicable.
Have you ever applied for and been denied a CCW license?
Have you ever held and subsequently renounced your United States citizenship?
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
List the firearms you'd like to include on your CCW.
Include the Manufacturer, Model, Serial #, Caliber, Barrel Length, Color for each firearm.
For Example:
Firearm #1-
Manufacturer: Glock.
Model: 17.
Serial #: ABCD123.
Caliber: 9mm.
Barrel Length: 4.49 in.
Color: Black.
*Please be aware that the number of allowed firearms on a CCW varies depending on the city or county.*
List all residential addresses you've lived in the past 5 years. Provide move-in dates, and move out dates (MM/YYYY). Write N/A if not applicable.
List the street address, county, state, zip code, move-in dates, and move out dates (MM/YYYY)
For Example : 1234 St., Orange, CA, 12345. Moved-in 01/20xx. Moved-out 01/20xx
List ANY Motor Vehicle Accident & Traffic Violation in the last 5 years. Provide the date, type of ticket/accident, ticket/report #, responding/issuing agency, and a brief description of what occurred. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records.
List ANY time you have ever been taken into custody as a danger to self or others for reasons related to mental health under Welfare and Institutions Code sections 5150 or 5585, or assessed under Welfare and Institutions Code Section 5151, or admitted to a mental health facility under Welfare and Institutions Code sections 5150 or 5152, or certified for mental health treatment under Welfare and Institutions Code sections 5250, 5260, or 5270.15. Write N/A if not applicable.
Provide dates, what agencies were involved, and a brief description. Include ALL incidents even if they've been expunged from official records.
List anytime you have been treated for mental illness. Write N/A if not applicable.
Provide dates, what offices/agencies were involved, and a brief description. Include ALL incidents even if they've been expunged from official records.
List any time you have ever been found not guilty by a reason of insanity or mentally incompetent to stand trial. Write N/A if not applicable.
Provide dates, what offices/agencies were involved, and a brief description. Include ALL incidents even if they've been expunged from official records.
List anytime you have you ever been addicted to a controlled substance or alcohol. Write N/A if not applicable.
Provide dates, what offices/agencies were involved. Brief description. Include ALL incidents even if they've been expunged from official records.
List if you have you ever reported to a detoxification or drug treatment program. Write N/A if not applicable.
Provide dates, what offices/agencies were involved. Brief description. Include ALL incidents even if they've been expunged from official records.
Click or drag a file to this area to upload.
If you are unsure if you have ticket(s), we recommend you obtain your Motor Vehicle Record at https://www.dmv.ca.gov/portal/customer-service/request-vehicle-or-driver-records/online-driver-record-request/
List any time you have engaged in an lawful or reckless use, display, or brandishing of a firearm. Write N/A if not applicable.
Provide dates, what agencies were involved (if any), and a brief description.
List any time you have ever been involved in an incident involving firearms. Write N/A if not applicable.
Provide dates, what agencies were involved (if any), and a brief description.
List ANY reason that you were detained or arrested in the United States or in any other country. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records and whether the detention or arrest resulted in criminal charges, and if so, the disposition
List ANY criminal offense you have been CONVICTED of (civilian or military) in the US or any other country? Provide dates, agency, charges, and disposition. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records.
List ANY lawsuit you are now or have been a party to within the last 5 years. Provide a brief explanation. Write N/A if not applicable.
Provide dates, courts, case #s, and a brief description.
List ANY restraining orders, protective order, or other type of court order issued pursuant to Penal Code Code section 646.91 (stalking); Part 3, commencing with section 6240, or Part 4, commencing with section 6300, of Division 10 of the Family Code (domestic violence or abuse); Penal Code section 136.2 (victims and witnesses of crime); Penal Code section 18100 (gun violence restraining order); Code of Civil Procedure section 527.6 (civil harassment); Code of Civil Procedure section 527.8 (workplace violence); Code of Civil Procedure section 527.85 (school violence); Welfare and Institutions Code sections 213.5, 304, 362.4, or 726.5 (juvenile court orders); or Welfare and Institutions Code section 15657.03 (elder/dependent adult abuse) you are now or have been subject to from ANY court. Provide a brief explanation. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records. Provide dates, what agencies were involved, and a brief description.
List ANY valid restraining, protective, or stay-away order issued by an out-of-state jurisdiction pursuant to laws concerning domestic violence, family law, protection of children or elderly persons, stalking, harassment, witness intimidation, or firearm possession. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records. Provide dates, what agencies were involved, and a brief description.
List ANY domestic violence incidents you were involved with. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records. Provide dates, what agencies were involved, and a brief description.
List ANY valid restraining, protective, or stay-away order issued by any court within the United States or by any out-of-state jurisdiction?
Include ALL incidents even if they've been expunged from official records. Provide dates, what agencies were involved, and a brief description.
List ANY offense that you are on probation, parole, post release community supervision, or mandatory supervision for (From any state, and offense including traffic violations). Provide a brief explanation. Write N/A if not applicable.
Include ALL incidents even if they've been expunged from official records.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
List any time that you have lost a firearm, or had a firearm stolen.
Include ALL incidents even if they've been expunged from official records. Provide dates, what agencies were involved, and a brief description.
Have you withheld any fact that might affect the CCW unit's decision to approve the license?

READ THE FOLLOWING THOROUGHLY. BY CHECKING THE BOXES YOU VERIFY THAT YOU HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS.

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