WIN/LOSS FORM by Riley Pearce | Jun 20, 2019 WIN/LOSS FORM 1 2 Statement Year*Statement Year20212020201920182017201620152014201320122011201020092008First Name*Last Name*Street Address*Address Line 2City*State/Province*ZIP Code*Phone Number*Email Address*Players Club Account #Birthday* Date Format: MM slash DD slash YYYY Consent* I hereby verify that I am the above person requesting the Win/Loss Statement from Wildwood Casino.* Form Format*Mailed to the address in my Club Wild AccountPick up at Wildwood Casino’s Players Club (must pick up within 24 hours)