Payment & EFT Submission
Application GLC-2026-00287 — John's Convenience Store #1
Your application has been approved for processing. Please complete both sections below to advance your application to Compliance Review.
Payment Declined — Your card ending in 4242 was declined by your bank. Please check your card details and try again, or switch to ACH bank transfer. No duplicate charge has been made.
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Section 1: Application Fee Payment
Your payment is processed securely by MerchantOne. No payment data is stored on GLC systems. All transactions are PCI-DSS compliant and use TLS 1.2 encryption.
3 digits on back; 4 on front for Amex
Section 2: EFT Authorization Documents
The GLC Retailer Contract requires a separate bank trust account titled "In Trust for the Georgia Lottery Corporation." Upload your signed EFT authorization form and any supporting bank documents below. Files are automatically scanned for malware before processing.
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eft_authorization_form.pdf
1.4 MB
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If your payment is declined, you may retry without creating a duplicate application or charge.
Secured by MerchantOne · PCI-DSS Level 1 Compliant · TLS 1.2 Encrypted · No card data stored on GLC servers
Payment Summary
Traditional Lottery Products — Application Fee
$125.00
Total Due Today
$125.00
Application Summary
Application #GLC-2026-00287
BusinessJohn's Convenience Store #1
LocationMarietta, GA 30060
SubmittedMay 28, 2026
Application fees are non-refundable once submitted. Both payment and EFT documents must be submitted together.