Win/Loss Statement Request Form

To obtain a statement of your gaming activity, please fill out the form below and attach a scan or photo of your valid photo ID and hit submit. Statements can be picked up in person at the Player Rewards Club, e-mailed to you, or mailed to your home. Mailed and e-mailed requests will be sent to the address on file.

PLEASE NOTE: Photo or scan of your valid photo ID is required for online request submissions. To protect the privacy of our players, we will not process requests without an attachment of a photo ID.

First Name *

Last Name *

Players Card # *

Date of Birth *

Email *

Phone *

Mailing Address

Mailing Address *

City *

State *

Zip *

Tax Year Requested *

Upload Your Valid Photo ID *

Click to upload or drag and drop

JPG, PNG or PDF (MAX. 10MB)

Method of Delivery *

Comments

* By submitting a request for a Win/Loss statement you acknowledge that SC Gaming OpCo LLC dba Happy Valley Casino shall not be responsible if you do not receive the requested information. In the event that the information provided by you has changed or no longer matches the information on file, we may be unable to satisfy your request. Please contact Happy Valley Casino if you need to change your information. This is not a tax document. By submitting this form you acknowledge and agree that you are requesting a Win/Loss Statement that will include estimated gaming Win/Loss information. The tracking system used in providing this information is based upon the terms and conditions and use of your Players Club card. Therefore, this statement will not reflect an accurate accounting record - it merely provides an unverified, estimate for comparison to your records. This is not a substitute for records required by you for applicable State or Federal tax laws. Furthermore, by submitting this form, you certify that the information inputted above is true and correct, and authorize Happy Valley Casino to provide a Win/Loss Statement of tracked gaming activity for your Players Club membership. You further understand that the information requested is generated from a guest's tracking system based upon Players Club account history and is not intended to be, or take place of, your own records of your gaming activity. Happy Valley Casino makes no representation or warranty, expressed or implied, as to the accuracy of this information or its effectiveness as proof of winnings and losses.

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