Riviera Hotel & Casino Las Vegas Hotel Win Loss Form

Club Riviera Account #*

Name*

FirstLast

Date of Birth*

Phone*

Email*

Tax Years Requested*

2011
2010

Please indicate your preference:

Please mail the letter to the address on file at the Riviera Hotel & Casino. To verify the mailing address we have on file, please call 800.637.5687
Please e-mail a pdf letter to the e-mail address noted above
Please use the e-mail address above to replace any previous e-mail address that may have been on file at the Riviera Hotel & Casino. I understand that this constitutes my agreement to receive promotional offers from the Riviera Hotel & Casino (Opt in not mandatory)

Please be advised that the Riviera Hotel & Casino sends this information as a courtesy only, and not as a legal document. If submitting to your tax consultant, or using for tax purposes, this letter represents only the estimated net results. All net results are based on observation and estimates by our gaming personnel and are not the result of our accounting system for recording revenue. Slot net win/loss information is the result of total coin-in minus total coin-out while playing with the slot card. Slot net win/loss information given in this letter is traced through your slot card. The net results provided do not include any activity at Riviera Black Hawk Casino nor does it include any tournament or drawing winnings, race and sports book or poker play.

Please mail my Win/Loss Statements automatically each year to the address on file at Club Riviera

If you are requesting information regarding a W-2G or 1099, please call the Riviera Casino Audit Department at 1-702-794-9234.

I agree to the terms and conditions set forth

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