Win/Loss Request

To receive a copy of your win/loss statement, please complete the form below (one for each person). Failure to complete this form accurately may delay our response in completing your request. Visit the Island Passport Club for same-day processing of your win/loss statement.

Win/Loss

Each request receives Win/Loss documentation. Requests will be processed within two weeks. Multiple requests will delay response time.

Win/Loss

Primary Name (as shown on Island Passport Card)*
For Income Tax Year(s)*
Island Passport Account*
Last four digits of Social Security Number*
Daytime Telephone*
Date of Birth*
MM slash DD slash YYYY
Your Email*
Annual Reports:
- Daily Detail
- Summary
Request*
- I hereby request that the Prairie Island Indian Community, d/b/a Treasure Island Resort & Casino furnish me with the requested recorded information for my personal use. I hereby hold PIIC and TIR&C harmless of any errors that may be contained within the requested document I also understand that the figures contained within the requested document may not be indicative of my complete gaming win and or loss and is only that of which was recorded while utilizing my personal Island Passport Club card.
Primary Account*
- By checking this box I verify that I am the primary account holder. I understand that falsifying my identity is a fraudulent act and is punishable by law.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Win/Loss

Win/Loss