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Illinois Lottery Application Form

Incomplete application will be returned. FIRST read the provisions in the Agreement for the Sale of Lottery Tickets and retain it for your records. SECOND complete and sign the Retailer Contract for Sale of Lottery Tickets. PAGE 1 Complete items 1-17. If you do not have a business or corporate email address enter N/A. For shipments of instant tickets circle either number 3 or 8 or provide a different address by attaching an additional page. PAGE 2 Provide the information requested as it applies.

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