Please print and fill in the form with the required information.

Tiverton Casino Hotel requires patrons to complete a Win Loss Form before the information may be released. You may also visit the Players Club in person to obtain and fill out this form.

PLEASE NOTE: 2018 statements will not be available until January, 2019.

Please mail the original request to:

Tiverton Casino Hotel
Attn: Marketing Dept. Denitsa Pasco (Win/Loss)
777 Tiverton Casino Blvd
Tiverton, RI 02878

Please present this request to Tiverton Casino Hotel Players Club (Casino Floor) with current and valid identification.
If this request is not presented in person, request must be notarized.
Incomplete request will be delayed pending missing information or rejected.
Tiverton Casino Hotel will mail the requested statement within two weeks of receipt.

Thank you.