winlossform Win-Loss Statement Request Win-Loss request form Name:Players Club Card Number:Social Security NumberDate of Birth: MM slash DD slash YYYY Mailing AddressCity, State, Zip Code:Telephone NumberEmail Address Please provide me with a statement of my gaming activity for the year:(Required)The following document(s):(Required) W2G 1099 W/L Statement Consent(Required) I agree to the terms below.By checking this box, the patron hereby releases S&K Gaming, L.L.C. (KwaTaqNuk Resort & Casino and Gray Wolf Peak Casino), its officers, directors, employees, agents from, and against any loss, cost, expense, (including attorney’s fees and costs), damages, liability or claims of any kind. Additionally, the patron hereby agrees to indemnify S&K Gaming, L.L.C. for, from and against any loss, cost, expense (including attorney’s fees and costs), damages liability or claims of any kind related to releasing this information. The undersigned acknowledges that the information being provided: is based on player tracking information which includes only the play when the undersigned’s players card was connected to the system, and may not accurately reflect the amount of the undersigned’s play since the undersigned can play when the card is not connected to the system, and is derived from a system that does not verify the identity of the person using the player card, and may not include estimated amounts to correct human error in putting information.
Recent Comments