Central Disputes System

Player Dispute Form

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To submit an investigation claim, please be sure to enter complete information below. If possible, please submit only one claim form. Please read the submission rules below.

Customer Information	Casino Information
First Name	Casino Name
Last Name	Account Name
Address	Claim Details
Adress 2	Claim Details
City	Claim Amount if Owed
State/Province	Was Faxback Form Submitted?	Yes No
Postal/Zip Code	Details of Your Claim
Country
Phone Number
E-mail

By submitting this form you are agreeing to the terms below:

The Payout Investigation Program is open to all players using RealTime Gaming software that abide these rules of the program:
All information submitted must be complete, including, but not limited to the list of all RTG licensed sites at which you have played, and the player IDs that you have used at those sites.
You may not submit false, misleading or incomplete information, nor have you submitted false, misleading or incomplete information to any site at which you have played.
Your account must be free from chargebacks.
You must have been 21 or older when deposits or wagers took place.
You may be required to send a faxback form directly to the Payout Investigation Program to complete the investigation of your claim.
You must have genuinely put your own money at risk.
Credit cards used to make deposits to your account must be registered in your name.
You must have abided by all rules at casinos at which you have played.
All claims must be submitted within 60 days of the date of dispute, or within 60 days of the inception of this program, whichever is later.
Mandate of Central Disputes System is for disputes occuring as of January 1, 2008.
All communications must be made in a courteous, professional manner.