Customer Detail
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Contact Information
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Residence Address
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Mailing Address
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Customer Declaration Information
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Select YES if you are a Michigan resident.
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Select YES if you are legally blind.
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Select YES if you are a student attending a Michigan college or university.
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Select YES if you are currently a full-time federal active-duty status in the US Military.
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Select YES if you are active duty serving in the Active US Military stationed in Michigan.
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Select YES if you are a 100% disabled veteran as deemed by the V.A. or individually unemployable as deemed by the V.A.
Customer Profile Acknowledgement Review

By selecting the 'Save' button you are agreeing to the State of Michigan policies, terms, and conditions and acknowledging the customer profile is accurate. A link to the State of Michigan Policies is listed below on the page footer.