Dealer's License Application

PLEASE FILL OUT THE FORM COMPLETELY AND CLEARLY.
Complete the entire application or your application will be deemed incomplete and may not be considered.

Please review the form below in advance for all the information that is required, and have that information ready to be entered. When you are ready to submit your application, fill in the form below.  Sign this form, and press the SUBMIT button to submit your form for processing.  To complete the Dealership Application Process, bring supporting documentation & fees to the VI Lottery Office.  All fields marked as (*) are required.

Alternatively, you can download a pdf version of the form, fill it out clearly and completely and bring it, along with the supporting documentation to the VI Lottery Office to complete the Dealership Application Process. Copies of this form are available on-line here:

Download VI Lottery Dealership Application Form

Are you a New Dealer Applicant, or is this a renewal of an existing Dealer's License?

If this is a renewal, please enter your Dealer Number.

Please enter your name as it appears on your ID

Enter a valid email address

Enter your date of birth

Enter your place of birth.

Enter your mailing address

Enter your City

Enter your State

Enter your zip code

Enter your home phone

Enter your work phone

Enter your cell phone number

Are you a United States Citizen? Select Yes if you are or No if you are not.

Are you a Naturalized Citizen? Select Yes if you are, No if you are not.

If you are a Naturalized Citezen, enter the date naturalized.

If you are a Naturalized Citizen, enter the Certificate of Naturalization #

Enter your Alien Registration / Work Permit #

Are you a Permanent Resident. Select Yes if you are, or No if you are not.

Have you ever been convicted of a felony? Select Yes if you have, and No if you have not.

If Yes, explain conviction

I certify that the information on this application and its supporting documents are accurate, true and complete as submitted to the Virgin Islands Lottery (VIL). I understand and agree that failure to fully complete this form or omission of facts represents grounds for elimination from consideration for a VIL Dealer’s License, or termination after a VIL Dealer’s License has been approved. Further, I understand that any misrepresentation or falsification of documents may result in criminal charges, imprisonment and/or fines, applicable to the laws of the U.S. Virgin Islands.

Sign Above
Write your signature above by using your mouse like a pen as you drawing your signature in the space above

Write your signature in the box above by using your mouse and holding it down like a pen as if you were drawing your signature.

Enter today's date

ALL APPLICANTS MUST PROVIDE VALID PROOF OF CITIZENSHIP OR PERMANENT RESIDENCY BY PRESENTING:

ONE OF THE FOLLOWING (CURRENT):

  • V.I. Driver’s License/Real ID
  • Passport/Passport Card/Government Issued ID
  • Naturalization Certificate or Permanent Resident Card

ALL ITEMS LISTED BELOW:

  • Original Police Record
  • TWO (2) wallet size photographs (2x2)
  • License Fee ($25.00 per year, 3 years max.)

After completing and submitting this form online (or by downloading the pdf document and filling it out by hand), please bring the required items listed above to the VI Lottery Office to complete your application process.

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