Win/Loss Request Win/Loss Statement, 1099, W2G Request Request Win/Loss Statement, 1099, W2G Request Document(s) Requested*Check all that apply. Requests will be processed within a timely manner of date received. All 1099's and/or W2G's requested are submitted to the Accounting Department and may take longer than estimated. Win/Loss Statement 1099 W2G Your Name* First Last Red Card Number*For these requests, you will need to provide your social security number.*If you do not wish to provide your social security number, you may visit our player's club, to fill out this form in person. Enter the number without dashes. Date of Birth* Date Format: MM slash DD slash YYYY Phone Number*Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year(s) Requested* 2019 2018 2017 2016 2015 How would you like to receive these documents?*Choose only one. Pick Up At Players' ClubPostal MailEmailEmailIf requesting that your documents be emailed to you, you must provide a valid email address. Consent*The win/loss document is not verifiable as a win/loss statement reflecting actual wagering activity and cannot be used for tax purposes. I hereby authorize High Winds Casino to release its officers, directors, employees, and agents from and against any loss, cost, expense (including attorney's fees and cost), damages, liability or claims of any kind. I agree to indemnify High Winds Casino from and against any and all suits, causes of action, liabilities, costs, losses, damages, and attorney's fees and costs which I or my spouse, administrators, executors, agents, assignees or any third party may have arising out of or relating to this request. I agreeAdditional InformationCaptchaNameThis field is for validation purposes and should be left unchanged.