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1500 330 St Sloan, IA 51055
Fax: 712.428.4043
Please note that submission of this form will ensure delivery of a W2G or Player Activity.
Please allow time for delivery through the United States Postal Service as we are not
able to email or fax tax information. Requests are processed in the order they are
received. If you are unsure of the status of your request or need further information
please call the Guest Services at 1.800.468.9466 ext. 6132 for Player Activity or
Finance Auditor at ext. 7156 for W2G information, or you may leave a voicemail after
office hours.
Year(s) Requested:
If no year is specified we will send information for the last complete gaming year.
Information Requested:
Player Activity:
W2G Replacements:
Yes or No
Yes or No
Player Information
Last Name:
First Name:
Date of Birth: (mm/dd/yyyy)
Player’s Club Account Number:
Social Security Number:
Telephone Number: (
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-
)-
-
Address
Street:
City:
State:
Zip Code:
Signature:
Date: