Retailer Application
535
MILLION BACK TO
NEBRASKA
Application forms are available to download here in Adobe PDF Format.


Part 1:   Application Form - Main

Part 1A: Attestation Form - (Only Sole Proprietorships need to complete.)

Part 2:   Application Form - Background Information

Part 3:   Application Form - Financial Information

Part 4:   Application Form - W-9 Taxpayer Identification


Completed applications can be submitted via FAX to 402-471-6108; or mailed to Nebraska Lottery, PO Box 98901, Lincoln, NE 68509-8901.