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Zain Khalifa EX-1249 10624-2022

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Mathias Koller EX-1250 10531-2022

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Prasanna Kumar EX-1251 10410-2022

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Gregory Lee EX-1252 10482-2022

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Alberto Leon EX-1253 10570-2022

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Molly Myers EX-1254 10615-2022

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Dwayne Perrin EX-1255 10535-2022

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Andrea Rosa Jr EX-1257 10558-2022

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Sean Schweitzer EX-1238 10510-2022

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PENNSYLVANIA
GAMING CONTROL BOARD

PA Gaming Control Board
303 Walnut Street, Commonwealth Tower, 5th Floor
Harrisburg, PA 17101
(717) 346-8300

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EMPLOYEE WEB EMAIL | REPORT A WEBSITE ISSUE

PRIVACY POLICY | Copyright © 2024 - PENNSYLVANIA GAMING CONTROL BOARD SITE BY ACUTA DIGITAL
NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

First Name

LAST NAME:
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HOME ADDRESS:
Home Address
PHONE NUMBER:
EMAIL ADDRESS:
DATE AND APPROX TIME OF INCIDENT:
COMPLAINT TYPE:
Complaint Number:
ONLINE SITE USED:
DEVICE TYPE:
USER/SCREEN NAME USED:
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.
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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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