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DeAndre Smith EX-1284 10575-2022

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Steven Seibert EX-1283 10737-2022

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Brian Lawrence EX-1282 10649-2022

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Paris Pennamon EX-1281 10689-2022

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Tysjhon McCreary EX-1280 10690-2022

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Shockee Wilson EX-1279 10673-2022

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John Tremblay EX-1278 10608-2022

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Jamie Strayer EX-1277 10682-2022

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Juqea Sears EX-1276 10359-2022

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Ashley Rodriguez EX-1275 10680-2022

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PENNSYLVANIA
GAMING CONTROL BOARD

PA Gaming Control Board
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Harrisburg, PA 17101
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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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