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Get Pechanga Win Loss Statement

REQUEST FOR WIN/LOSS STATEMENT This is a request for a Win/Loss Statement. I am requesting a copy of my win/loss activity from my Rewards Club card records for the year of 2011 2012 2013 2014 2015 2016 Please circle year requested W-2G requests must be submitted separately by completing a W2-G request form DATE CLUB CARD FULL NAME DATE OF BIRTH Contact Information Method of Delivery Check one E-Mail Mail Fax E-mail Address Phone Number Fax Number Please allow up to 10 business days to process and additional days for delivery. Pechanga Resort and Casino PRC will not be held responsible for misdirected Win/Loss Statements. The signature below releases PRC from any liability. REQUEST FOR WIN/LOSS STATEMENT This is a request for a Win/Loss Statement. I am requesting a copy of my win/loss activity from my Rewards Club card records for the year of 2011 2012 2013 2014 2015 2016 Please circle year requested W-2G requests must be submitted separately by completing a W2-G request form DATE CLUB CARD FULL NAME DATE OF BIRTH Contact Information Method of Delivery Check one E-Mail Mail Fax E-mail Address Phone Number Fax Number Please allow up to 10 business days to process and additional days for delivery. Pechanga Resort and Casino PRC will not be held responsible for misdirected Win/Loss Statements. The signature below releases PRC from any liability. PRC cannot release information to anyone other than to the original person requesting the Win/Loss. All Win/Loss requests will be sent to the address in our database. Signatures can and will be verified prior to the release of any information* Signature Date The Club at Pechanga Use Only Received By Received Date Completed by P. Pechanga Resort and Casino PRC will not be held responsible for misdirected Win/Loss Statements. The signature below releases PRC from any liability. PRC cannot release information to anyone other than to the original person requesting the Win/Loss. PRC cannot release information to anyone other than to the original person requesting the Win/Loss. All Win/Loss requests will be sent to the address in our database. Signatures can and will be verified prior to the release of any information* Signature Date The Club at Pechanga Use Only Received By Received Date Completed by P. Pechanga Resort and Casino PRC will not be held responsible for misdirected Win/Loss Statements. The signature below releases PRC from any liability. PRC cannot release information to anyone other than to the original person requesting the Win/Loss. All Win/Loss requests will be sent to the address in our database. Signatures can and will be verified prior to the release of any information* Signature Date The Club at Pechanga Use Only Received By Received Date Completed by P.

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