Win/Loss Statement

Win/Loss Statement

Please fill out the form below to receive your win/loss statement. Please allow 2-3 weeks for processing.

Today's Date*
MM slash DD slash YYYY
Name (First, Middle & Last)*

Providing your middle name will help us differentiate you from those with a similar name.
Email*
Phone*
(###) ###-####
Player's Card Number (or Birth Date)*

Providing your player's card number or birth date will help us ensure we are looking up the correct person.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If the address you provide is different than the one we have on file, you must go to the Player's Club with your personal ID in order for us to change the address on your account.
How Would You Like To Receive Your Statement?*
- Mailed to You
- Picked Up at the Player's Club
MAILED TO YOU: Your statement will be mailed to the address we have on file. To change your address you must come in person to the Player's Club with your ID to change it.

PICKED UP: Your statement can only be picked up by you.
What Year or Years Do You Want Your Statement(s) for?*

If you have any issues with this form please email comments@clearwatercasino.com