Retailer Application

Please contact the Lottery offices with questions on filling out your application at 307.432.9300.
You may also email dstevens@wylotterycorp.com.

Application Type*
- New Retailer Contract
  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).

Applicant Information*

Please enter the primary applicant’s information.

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Is the business a Sole Proprietorship?*
Yes

No
Is the Sole Proprietor's information different than the applicant information above?
Yes

No
Is the business a Partnership?
Yes

No
How many partners are there?
How many locations or businesses are you applying for?

Owner/Partner Information #*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #1*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #2*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #3*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #4*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #5*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #6*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #7*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #8*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #9*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Owner/Partner Information #10*

First Name*
Last Name*
Date of Birth*
mm/dd/yyyy
Social Security #*
######### (no dashes)
Email Address*
Business Phone*
xxx-xxx-xxxx
Other Telephone
xxx-xxx-xxxx

Physical Address*

City*
State*
ZIP Code*
xxxxx (5 digit)

Driver's License Number*
State of Driver's License*

Retail Business / Location Information # *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 1 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 2 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 3 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 4 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 5 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 6 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 7 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 8 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 9 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 10 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 11 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 12 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Operations and Sales
When did the business open?*
MM/YYYY
Provide your average annual customer count/foot traffic*
Provide annual sales amount reported to the IRS for your last business year.*
If new business, report sales to-date.
Liquor License and Business Info

Does this location hold a liquor license?*
Yes

No

What type of liquor license does this location hold?*

Full

Bar

Restaurant

County/Malt

Beverage/Temp

Local Liquor License #	State Liquor License #

Has the liquor license ever been revoked/denied/suspended?*

Yes

Please explain why your license was revoked/denied/suspended.

Type of Building*
Free-Standing

Strip Mall

Mall

Office Building

Retail Business / Location Information # 13 *

Federal Employee ID Number*
XX-XXXXXXX
When filing taxes with the IRS, what is the Owner/Company name filed under?*
Legal Business Name*
Person Responsible/Liable for the Business*
Business Phone*
xxx-xxx-xxxx
DBA Business Name (if different)
Responsible Party Email Address*
Other Phone*
xxx-xxx-xxxx
Street Address*
- City*
- County*
- State*
- ZIP Code*
  xxxxx (5 digits)
Legal Business Type*
Schedule C

Partnership

S-Corp

C-Corp

Sole Proprietor

Limited Partnership

LL Partnership

Unincorporated Association

Not for Profit

LLC

Type of Business Applying for WyoLotto Terminal*
Convenience Store with Gas

Convenience Store w/o Gas

Gas Station

Liquor Store

Drug Store

Grocery Store

General Merchandise

Hotel/Motel

Bar/Restaurant

Truck Stop

Co-op

Lumber Yard

Tobacco Store

Feed Store

Check Cashing

Hardware Store

Eateries

Coffee Shop

Gift/Novelty

Pawn/Thrift

Not for Profit
Business Hours (Open to Close)*

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

Vendor Hours (If Different from Business Hours)

Retailer Application

Please contact the Lottery offices with questions on filling out your application at 307.432.9300. You may also email dstevens@wylotterycorp.com.

Please contact the Lottery offices with questions on filling out your application at 307.432.9300.
You may also email dstevens@wylotterycorp.com.