Northstar Lottery Group

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Vendor Registration Form

Please complete this form so that you can receive email notifications about our procurement opportunities. All fields are required.

E-Alert Options *





Contact Person


Please list value only, no dollar sign ($) necessary.






Company must be at least 51% owned and controlled by an individual or individuals who meet one or more of these business types. Please select all that apply.








Please provide the following information for each owner/officer:

Name

Please list value only, no percentage sign (%) necessary.


Name

Please list value only, no percentage sign (%) necessary.


If "Other" is selected, please use "Products and Services" box below to describe your business in addition to listing products and services.

Please provide a brief description of the products and services your company provides.

By checking the box, you certify that the information you have provided is accurate and that you are an authorized representative of the company.

Name