Win/Loss Statement Request

Please provide me with a win/loss statement of my gaming activity for the year(s) (required)

Select a gaming activity type: (required)

SlotBingoCopies of Jackpot Forms

First Name (required)

Last Name (required)

Player ID Number (required)

Date of Birth (required)

Contact Information


Telephone Number (required)

Email (required)

Additional Notes (optional)

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**Please click and drag text box below for larger type area**

Please Select a Delivery Option

Mail Form to my addressLeave Form at Player's Club for pick-up

Account Holders Verification

I do herby certify that the statements contained herein are true and correct and I Herby authorize Win-River Casino, its Subsidiaries, Affiliates and Agents, to provide me a Win/Loss Statement of my gaming activity derived from my Players Club account. I agree to indemnify and hold harmless Win-River Casino and its respective past and present agents, employees, managers, representatives, officers, directors, successors and affiliated persons, organizations and companies from any and all suits, causes of action, liabilities, costs, losses, damages, attorney's fees and expenses which I, or my administrators, or executors, agents, assignees or any third party may have arising out of or relating to this request. I understand the information requested is generated from internal marketing systems and is not intended to be or take the place of my own records of gaming activity. Win-River Casino makes no representation or warranty, express or implied, as to the accuracy of this information or its effectiveness as proof of losses. By signing this form I am acknowledging that I have the legal right to request this form.

Account Holder's E-Signature (required)


You may also download and complete the Win/Loss Statement Form as a PDF and mail it to us directly.

Please mail your completed request form to:

2100 Redding Rancheria Rd.

Redding, CA 96001

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