Forms for Current Retailers

Send a print out of the completed, signed forms to where specified on the form.

You can fill out the following MS Word forms and save them on your computer. Then print, sign and send them in. You might be able to fill in forms in PDF format, depending on the version of PDF reader you use. If you don't have a PDF reader, you can download one free from many web sites (exit this web site-Google search).

Applications | Terminals | Instant Tickets | Administrative | Other

Form Name	Form Number or Revision Date
Applications
Application to Add an INDEPENDENT location You will need to send in the following three forms. You can download all in .zip format or dowload them individually. Application to add a location including instructions W-9 (PDF) EFT (Electronic Funds Transfer) Application with instructions	12/07 11/07
Application to Add a CHAIN location (applicable to retailers with 3 or more locations with the same bank account) Application to add a location within a chain including instructions	12/07
Terminals
Wireless Installation Authorization (PDF)	10/06
Instant Tickets
Adjustment Form (PDF)	WL-146
Holiday Call Plan (PDF)	06/08
Instant Ticket Return (PDF)	WL-353
Retailer Agreement for Placement and Operation of Wisconsin Lottery Instant Ticket Vending Machines (ITVM) Criteria	12/07
Validation Codes (PDF)
Administrative
Change EFT Bank/Transit Information	12/07
Discontinue a location	12/07
Personal Data Form	11/07
Retailer Name and/or Address Change Notification	12/07
Other
Winner Claim Form (PDF)

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