
Please send E-Mail to: gaming@casinocom.com and request Printable PDF Document of the file shown above.
Please Email in PDF Format or Fax the Completed and Notarized Form, along with a SIGNED
AND COMPLETED PAGE Two(2), & a Photo Copy of Your Drivers License or
Passport Page with your identification shown clearly to (702)-655-8385,
and Mail The Original Completed Hard Copy of BOTH FORMS & PHOTO COPIES To:
Jack Benson, PO Box 570665, Las Vegas, NEVADA
89157-0665
Printable Adobe PDF Document of the above
form located at:
You must complete Page Two of this form.
