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Win-Loss Statement
"
*
" indicates required fields
1
2
Statement Year
*
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
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2010
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First Name
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Last Name
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Street Address
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Address Line 2
City
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State/Province
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ZIP Code
*
Phone Number
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Email Address
*
Players Club Account #
Birthday
*
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 Account
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