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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 dstevens@wylotterycorp.com.


    • 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  
      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  
      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 #




     
    If you answer “yes” to any of the following questions, provide an explanation in the space below.
    • A.
    • B.
    • C.
    • D.
    • E.
    • F.
    • G.
    • H.
    • I.
  •  
    Please enter any additional information that may be relevant to your application, or explanations to the above questionnaire.
  • Lottery agrees to keep the information submitted in this Application confidential and to not publicly or privately disclose such information, unless necessary for Lottery operations or otherwise required by law.

    I hereby certify that I am authorized either as the applicant or authorized to act on behalf of the application. I certify that the information provided to the Wyoming Lottery Corporation is true and complete. I understand and consent to an investigation of my personal/business credit history, business and personal financial records, criminal history, and any other matter pertaining the the authenticity of statements made in this application process; this authorization includes the use of personal identifying information for the purposes stated in this paragraph. I understand and consent to inspection by any law enforcement official or duly authorized state lottery official without a warrant or other process, of my premises to determine whether I am complying with the provisions of the Wyoming Lottery Laws and Wyoming State Statutes. I further understand that a false answer to any of the foregoing can subject the applicant to denial, suspension or revocation of this contract. I certify under penalty or perjury that all of the information in this Retail Application is complete and correct to the best of my knowledge and belief.
    By clicking “I Accept” and submitting your application, you agree to be legally bound by the terms and conditions of the application and agree that you are signing this agreement electronically. You agree that your electronic signature shall have the same legal effect as your handwritten or manual signature. You are expressly encouraged to print and/or save a copy of this consent to electronically sign and to print and/or save a copy of your application.
    • Type your name as you would sign.
  •  
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