Win/Loss Statement

Request Win/Loss Statement

Please fill in all fields below to request your Win/Loss statement. Print out the form below for faster processing on site. Win/Loss statements are available to view on-site by visiting a promotional kiosk and providing your PIN number. Please allow up to 12 business days for processing.

Tax Request Form

"*" indicates required fields

Name*

Email*

Date of Birth*

Social Security*

Driver's License / ID #*

Rewards Card Number*

Street Address*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

Signature:

*If the above address differs from the address on file, please download, sign, and email the signed form to winloss@colusacasino.com.

Tax Year Requested*

Please mark the form(s) requested:*

Win/Loss Statement Only: A report that summarizes a guest's gambling activity as tracked by their Reward's Club Card.

W2Gs and 1099s

I hereby release Colusa Casino Resort and their respective: Owners, Directors, Employees, and agents from any and all claims arising from or relating to the information and its release, and further agree to indemnity and hold those entities and persons harmless from any such claim. No documents will be generated until January 31. All requests will be mailed to the address on file. If the address above is different than the address on file, you must print out this form sign it and send it back in one of two ways, (1) US Mail or (2) E-Mail to winloss@colusacasino.com. If you request to pick up your form leave a phone number and we will call you when your documents are ready. You must show a current valid government ID to pick up any documents.
Please allow 12 business days for processing. No documents will be given to any individual other than the party listed on the W2G/1099, unless that person is deceased. In that case, a certified death certificate copy must be presented along with proof that you are the executor of the estate, the spouse of the deceased, or beneficiary of an estate trust.

Phone

This field is for validation purposes and should be left unchanged.

Scheduled Maintenance

Win/Loss Statement

Request Win/Loss Statement

Tax Request Form

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