About Us > Request For Lottery

Request For Lottery

Complete the form below to express interest in being a Lottery Retailer. A Lottery Representative will contact you for further information.
Failure to provide contact information for all required applicants, will result in delay of processing and possible rejection of the application.

TYPE OF REQUEST:

 Change of Owner
 New Business / Construction

RETAIL LOCATION INFORMATION:

All Owners, Members of an LLC, officers, directors, and shareholders of a corporation, must provide their name and email address

TYPE OF BUSINESS (Check one):

 Grocery Store/Market
 Liqour Store
 Restaurant/Lounge
 Convenient Store and Gas
 Service Station
 General Merchandise
 Convenient Store W/O Gas
 Drug Store
 Bar/Tavern/Pub
 Fraternal Organizations
 Bowling Centers
 Other (Specify):
Submit

COMPLETE THIS FORM TO EXPRESS INTEREST IN BEING A LOTTERY RETAILER. A LOTTERY REPRESENTATIVE WILL CONTACT YOU FOR FURTHER INFORMATION. TO BECOME A LOTTERY RETAILER, APPLICANTS MUST SUCCESSFULLY COMPLETE THE LICENSING AND APPLICATION PROCESS IN KRS 154A AND 202 KAR 3:030.