Objective: To assess indoor tanning facility practices in a sample of facilities in 116 cities representing all 50 states. Design: Cross-sectional study. Setting: United States. Participants: Employees of 3647 indoor tanning facilities were contacted by telephone. Data collectors (ie, confederates) posed as prospective, fair-skinned, 15-year-old female customers who had never tanned before. Main Outcome Measures: Confederates asked respondents about their facility's practices related to parental consent, parental accompaniment, and allowable tanning session frequency. Results: Approximately 87% of the facilities required parental consent, 14% required parental accompaniment, 5% said they would not allow the confederate to tan owing to her age, and 71% would allow tanning every day the first week of indoor tanning. In Wisconsin, which bans indoor tanning among those younger than 16 years, 70% of facilities would not allow the confederate to tan. Multivariate analyses indicated that facilities in states with a youth access law were significantly more likely to require parental consent (P<.001) and parental accompaniment (P<.001) than those in states without a youth access law. Law was not significantly related to allowable tanning frequency (P=.81). Conclusion: We recommend that additional states pass youth access legislation, preferably in the form of bans.