Utah Draw System Customer Profile

New Customer

Complete all information in order to create a new customer record.

To ensure you're eligible for upcoming draws, please double-check your demographic information. If anything is missing or has recently changed, update it now before continuing. Accurate info helps us process your application without delays.

Customer Identification

Date of Birth*:

Social Security Number:

Show SSN

Driver's License / State ID:

State Issued:

Identification Type:

Country Issued:

Number:

Customer Legal Name and Details

First Name*:

Middle Name:

Last Name*:

Suffix:

Gender*:

Hair Color*:

Eye Color*:

Weight (lbs)*:

Height*:

ft. in.

Contact Information

Mobile Phone*:

Home Phone*:

Mobile Phone:

I agree to receive SMS notifications

By checking this box, I consent to receive essential text messages at the Mobile Phone number provided above. These may include reminders, payment notifications, receipt confirmations, and draw results. These are not marketing messages. Message & data rates may apply. Message frequency will vary based on your activity. Reply STOP to opt out or HELP for assistance. Please refer to our Mobile Terms of Service and Privacy Policy for additional information.

Email Address:

Decline to provide Email Address

Customer Address

Country*:

Mailing Address*:

Apt/Unit:

Zip/Postal Code*:

City*:

County*:

State*:

Zip/Postal Code*:

City*:

Attention Line (If Needed):

Cancel Create

New Customer

Link Customer Profile

Customer Identification

Customer Legal Name and Details

Contact Information

Customer Address

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