Retailer Application at a glance
What it is: The Retailer Application is the retailer contract and application for retailers interested in selling Michigan Bureau of State Lottery products.
Where and when to file: Send completed documents to: Michigan Lottery Attn: Retailer Services P.O. Box 30023 Lansing, MI 48909
Most applicants with an acceptable credit history and no criminal record that would adversely affect the integrity of the Lottery may be licensed.
Any criminal record must be disclosed on Personal Data Sheets.
A filled-in Retailer Application example: an LLC applies for its shop
How to fill out Retailer Application, box by box
Business or organization name, number and street, city and county
Enter the Business / Organization Name, Number and Street, City and County.
Enter the Zip Code, Phone Number and Fax Number.
Date business was purchased and current retailer number
Enter the Date Business Was Purchased by You and the Current Lottery Retailer Number of This Location (if applicable).
Americans with Disabilities Act
Answer YES or NO: Is this location in compliance with the requirements of the Americans with Disabilities Act?
Mailing address if different from business address
Enter the Mailing Address if different from business address: Name, Street Address or P.O. Box, City and ZIP Code.
Nature of application
Nature of application: New License, Change of Ownership, Add Partner, Drop Partner, Stock Transfer, Change in Business Type, Change in Officers/Chairperson, or Other.
Business type
Indicate business type: Sole Proprietorship, Partnership, Limited Partnership, Limited Liability Company, Corporation, or Non-Profit Corporation.
FED ID # (FEIN) and legal entity name
Enter the FED ID # (FEIN). All businesses other than sole proprietorship must provide the Legal Entity Name.
Principal business
Check the box showing your principal business.
Liquor license numbers
Write the applicable Michigan Liquor Control License(s) number issued to the applicant for this business, at this location (If pending receipt, write pending): Class C, SDM, SDD, Brewpub.
Hours of operation
Enter the hours of operation: Open and Close for Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday.
Individual, corporation or organization and DBA
Enter the Individual(s) / Corporation / Organization and the DBA (Doing Business As) in the contract with the Michigan Bureau of State Lottery.
The contract shall take effect on the day the Lottery license is issued and shall continue until terminated by written notice by either party or until a mutually agreed date of termination.
Who signs below
Each owner/shareholder/principal officer/Lottery chairperson signs (add sheet, if needed).
Type or print name of individual, signature, date, title and percent of stock.
A Personal Data Sheet is required for person(s) signing and additional owner(s)/shareholders as described on the Applicant Information sheet; enter the number of Personal Data Sheets submitted.
Each of the undersigned persons represents and warrants that s/he has reviewed and fully understands the Contract and that s/he is a person authorized to execute this Contract and bind the Retailer to its terms and obligations.
More rules for Retailer Application
Submission of application and fee does not guarantee equipment placement.
Rule 432.4 provides that the Retailer's license may be immediately suspended or revoked or its renewal rejected if the application for license contains false or misleading information.
If your situation is different
A Proprietorship signs
A Proprietorship may use the owner's Social Security number as a tax identification number or s/he may have a registered Federal Employer Identification Number (FEIN). The owner must complete and sign the contract and submit a Personal Data Sheet.
A partnership signs
Each Partner must sign the contract and Personal Data Sheets must be provided for all partners.
A Limited Partnership signs
A Limited Partnership is a business enterprise, doing business under an assumed name, that IS registered as a Partnership with the Michigan Department of Labor & Economic Growth. A General Partner must sign the contract and Personal Data Sheets must be provided for all general partners.
A Limited Liability Company signs
A Limited Liability Company is a business enterprise, doing business under an assumed name, that is registered as an unincorporated association with the Michigan Department of Labor & Economic Growth. Members are required to sign the contract and submit Personal Data Sheets.
A closely held corporation signs
A Closely Held Corporation means a corporation where a majority (more than 50 percent) of the outstanding voting stock is owned by ten or fewer persons. A Personal Data Sheet is required for each owner/shareholder, except that any individual owning less than 10 percent may be listed on a separate sheet of paper and is required only to provide name, Social Security number and percent of ownership. Any person authorized and empowered to execute contracts and bind the corporation to its terms and obligations may sign the contract.
A non-closely held corporation signs
A Non-Closely Held Corporation means a corporation where a majority (more than 50 percent) of the outstanding voting stock is owned by more than ten persons. The Principal Operating Officer(s) is/are required to sign the application and submit Personal Data Sheet(s).
Before you go
Your completed application must contain the following (an incomplete application can result in delay): Retailer Contract/Application, Personal Data Sheet (one data sheet for each owner/shareholder).
Identification (Out of state applicants must provide a photocopy of their driver's license, social security card, and one other piece of identification.)
W-9 Form. Copy of IRS Notice CP 575A (Notice sent to you by IRS showing your Employer Identification Number); this requirement excludes sole proprietorships.
Applicants should submit a completed Electronic Funds Transfer (EFT) Authorization Form with the application (Include a void check or a letter, on bank letterhead, with the bank's routing number and your checking account number).
Liquor Control License Number, Bill of Sale or Proof of Ownership (property tax statement, lease, rental, or land contract, etc.).
Communications Equipment Installation Approval Sheet (Form is not required IF equipment is already installed).
Common questions about Retailer Application
Is there a deadline?
If you plan to sell your business and the buyer wants to continue Lottery sales, a change of ownership must be approved by the Lottery. The buyer should submit an application approximately 45 days prior to closing.
Where do I file it?
Send completed documents to: Michigan Lottery Attn: Retailer Services P.O. Box 30023 Lansing, MI 48909
Are there fees?
A nonrefundable application fee of $150 is due at time of application (checked November 2, 2026). A communication equipment installation fee of $550 will be withdrawn from your account after the equipment is installed. The application fee may be remitted by check payable to the State of Michigan or paid on-line.
Is there a penalty?
COMPLETION: Required. PENALTY: Denial of application.
Sources
[1] Retailer Application (Rev. October 2019), Michigan Bureau of State Lottery (the Official source link on this page).
