Double Eagle- Win/Loss Statement

As a service to our valued Premier Club Members, we provide an online Win/Loss Request form for tax purposes. To request a win/loss statement, download/print form, fill out and mail with proper postage to:

Double Eagle Hotel & Casino and Gold Creek Casino
P.O. Box 1588
Cripple Creek, Colorado 80813

Win Loss Activity Request Form

Win/loss information has been gathered using our Player Tracking System (IGS). It is is intended to be used as an estimate of your win/loss and is provided as a courtesy and is not an official tax document. The information is based on player-tracking information which includes only win/loss from slot play when a player’s club card is inserted in a slot machine and points added from table game play. It may not accurately reflect the amount of a player’s win/loss if the player does not play with a player’s card inserted into a slot machine. Although this information can be considered a reliable estimate of the win/loss from rated play, the Double Eagle and Gold Creek Casinos are in no way responsible for the use or interpretation of said document.

Upon receipt of this form, we will gather the data and mail a Win/Loss Statement to the address you provide to us. Requests for information can only be granted to those with a valid Premier Club Card. Third party requests must be made in person at the Premier Club.

Please print legibly and complete ALL blanks. Incomplete requests will not be processed.

Guest Name: ______________________________ Guest Card #: ______________

Day Telephone #: ( ) ________________ Social Security # : ___________________

Current Address: ______________________________________________________

City: ________________________________ State: ________ Zip Code: _________

Information requested from: __________, 20_____ through ___________, 20______

SIGNATURE: ________________________________ DATE: __________________