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Retailer Application

Please contact the Lottery offices with questions on filling out your application at 307.432.9300.
You may also email [email protected].


    • Please allow a minimum of 15 minutes to complete. At the bottom of this application, you will have the opportunity to provide notes and additional information about your business(es).
  • Please enter the primary applicant’s information.
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)





    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
    • mm/dd/yyyy
    • ######### (no dashes)
    • xxx-xxx-xxxx
    • xxx-xxx-xxxx
    • xxxxx (5 digit)
  •  
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday  
      Both a Start time and End time selection are required. Examples: 6am-11pm or Open 24hr-Open 24hr

    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday

    • MM/YYYY
    • If new business, report sales to-date.



      • Local Liquor License # State Liquor License #




     
    • XX-XXXXXXX
    •  
    •  
    •  
    • xxx-xxx-xxxx
    •  
    •  
    • xxx-xxx-xxxx
      •  
      •  
      •  
      • xxxxx (5 digits)
      •  


    • Sunday Monday Tuesday Wednesday Thursday Friday Saturday