Follow the steps to complete your request form effortlessly.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering your full name in the designated field. Ensure that the name matches the one associated with your Empire Card account to avoid processing issues.
3. Input your Empire Card account number in the appropriate space. This number is critical in retrieving your accurate gaming activity records.
4. Provide your Social Security Number. This information is necessary for identification and verification purposes.
5. Enter your date of birth. Ensure that this information is correct, as it helps confirm your identity.
6. Fill in your mailing address, including the city, state, and ZIP code. This is the address where your Win/Loss statement will be sent.
7. Input your telephone number for any follow-up communications regarding your request.
8. Provide your email address. This allows for digital communication regarding your Win/Loss statement.
9. Read and sign the certification statement, confirming that the information provided is truthful. This section may require your physical signature.
10. Enter the current date next to the signature line to indicate when the request is made.
11. Once you have filled out the form, you can choose to save your changes, download the file, print a copy, or share it, depending on your preferred method of submitting the request.

Complete your Empire City Casino Win/Loss Statement Request Form online today for a streamlined request process.