First Name
Home Address
Phone Number
Email Address
Date and Approx Time of Incident
Address of VGT
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.
Make sure the entire form is completed and read the information below before clicking on the "I Understand" button to complete your complaint.
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. For instructions, please reference the confirmation email that will be sent you once this form is submitted
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