Get Self-exclusion Revocation Request

Filling out the Self-Exclusion Revocation Request online is a straightforward process designed to help users regain access to gaming activities after a voluntary exclusion period. This guide provides comprehensive, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete your request.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the personal information section by entering your first name, middle name, last name, and any former names you may have used.
3. Provide the last four digits of your Social Security number, and enter your date of birth in the format Month/Day/Year.
4. Fill in the approximate date of your exclusion. This date will be verified, so ensure it is as accurate as possible.
5. Enter your email address and driver’s license number in the designated fields.
6. Complete the address section by providing your street address, city, state, and zip code.
7. Review the statements regarding liability and revocation acknowledgment carefully. This section outlines the legal considerations and confirms your understanding of the process.
8. Certify the information provided by adding your signature and today’s date at the bottom of the form.
9. After completing the form, you can save your changes, download the form for your records, print it, or share the completed form as needed.

Take the next step and fill out your Self-Exclusion Revocation Request online today.