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Personal Information:
Title:
Full Name:
Address 1:
Address 2:
City:
State / Country:
Zip Code:
Country:
Phone Number 1:
Phone Number 2:
E-mail:
 
Problem Information:
Platform:
Casino name:
Casino username:
Have you contacted
the casino about
your claim?		 Yes  No
Have you charged
back this account,
either on this
occasion or in the
past?		 Yes  No
Details of your
claim:*
 
I hereby agree of the terms below:
  • I have an account in a Playtech-powered casino
  • All information I am submitting is true and complete.
  • I was of the legal age in my jurisdiction or older when the deposits or wagers in question were made.
  • Any financial instrument used to make deposits in my account are registered in my name.
  • I abided by all rules at the casino/s at which I played.
  • I am submitting my claim/s within 60 days of the date of the dispute in question.
marked fields are required.