New Complaint Form - Casino / SportsBook 7/2019 - Pennsylvania Gaming Control Board

Casino / Sportsbook Patron Dispute/Complaint Form

Questions or comments regarding patron disputes or complaints can be directed to the Pennsylvania Gaming Control Board at casinocomplaints@pa.gov.

PLEASE COMPLETE ALL INFORMATION - BE AS DETAILED AS POSSIBLE

Name of individual filing a
dispute or complaint:



Home Address:

City, State, Postal Code:



Phone:

E-mail Address:

Date and Approx Time of Incident:

Complaint Type (choose one)

Casino
Sportsbook - A PHYSICAL SPORTSBOOK - NOT ONLINE

Licensed Gaming Entity Where Incident Occurred:

Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.

By submitting this patron complaint/dispute form, I understand that I am making a request for an investigation of this matter by the Pennsylvania Gaming Control Board and declare that all information provided on the pages of this form and on any pages that I attach hereto are true and factual to the best of my knowledge. I further understand that if I have knowingly, intentionally or willfully made false statements or intentional misrepresentations that I may be subject to the penalties for violations of 4 Pa.C.S. §1518(a)(1), relating to perjury, false swearing and unsworn falsifications. I further acknowledge that as part of the investigation, the Pennsylvania Gaming Control Board may contact the licensee or game provider in order to obtain further information relating to my complaint/dispute.



ATTACHMENTS or DOCUMENTATION?
While NOT REQUIRED to file a complaint, after completing this form, if you have items (texts, screen shots, emails, etc.) relating to this complaint, you can send them in a separate email by clicking the YELLOW BUTTON* you will see on the "Thank You for your Submission" page, or the CLICK HERE* link in the email you will receive to confirm your complaint / dispute submission.

* This button - or link - will open the mail application on your computer, tablet, or phone
allowing you to send attachments to us. For security reasons, only certain file types are allowed.

PLEASE COMPLETE ALL INFORMATION - BE AS DETAILED AS POSSIBLE
Name of individual filing a dispute or complaint:
Home Address:
City, State, Postal Code:
Phone:
E-mail Address:
Date and Approx Time of Incident:
Complaint Type (choose one)	Casino Sportsbook - A PHYSICAL SPORTSBOOK - NOT ONLINE
Licensed Gaming Entity Where Incident Occurred:
Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.
By submitting this patron complaint/dispute form, I understand that I am making a request for an investigation of this matter by the Pennsylvania Gaming Control Board and declare that all information provided on the pages of this form and on any pages that I attach hereto are true and factual to the best of my knowledge. I further understand that if I have knowingly, intentionally or willfully made false statements or intentional misrepresentations that I may be subject to the penalties for violations of 4 Pa.C.S. §1518(a)(1), relating to perjury, false swearing and unsworn falsifications. I further acknowledge that as part of the investigation, the Pennsylvania Gaming Control Board may contact the licensee or game provider in order to obtain further information relating to my complaint/dispute.

ATTACHMENTS or DOCUMENTATION? While NOT REQUIRED to file a complaint, after completing this form, if you have items (texts, screen shots, emails, etc.) relating to this complaint, you can send them in a separate email by clicking the YELLOW BUTTON* you will see on the "Thank You for your Submission" page, or the CLICK HERE* link in the email you will receive to confirm your complaint / dispute submission. * This button - or link - will open the mail application on your computer, tablet, or phone allowing you to send attachments to us. For security reasons, only certain file types are allowed.

Casino / Sportsbook Patron Dispute/Complaint Form

* This button - or link - will open the mail application on your computer, tablet, or phoneallowing you to send attachments to us. For security reasons, only certain file types are allowed.

* This button - or link - will open the mail application on your computer, tablet, or phone
allowing you to send attachments to us. For security reasons, only certain file types are allowed.