GAMING ACTIVITY

PLAYER’S CLUB CARD GAMING ACTIVITY REQUEST AND/OR W2G & 1042S

I am requesting my Player’s Club Card gaming activity information and/or W2G & 1042S from Bear River Casino Resort. By selecting this checkbox I am allowing Bear River Casino Resort to send a copy of the information I have requested to the address below, and all of the information listed below is correct.

Information Requested

Player’s Club Card Gaming Activity W2G Summary Copy of W2G/1042S forms

First Name

Last Name

Phone Number

Last four of SSN/ITIN

Mailing Address

City

State

Zip Code

Email

Driver’s License Number

Upload Picture of your government ID

Player’s Club Card Number

Delivery

Due to the sensitive nature of the requested information, these forms cannot be sent via email.

UNLEADED

4.69*

DIESEL

5.51*

GAMING ACTIVITY

PLAYER’S CLUB CARD GAMING ACTIVITY REQUEST AND/OR W2G & 1042S

E-LIST SIGNUP