Patron Disputes & Complaints

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TYPE OF REPORT – PLEASE CHECK ONE

PATRON COMPLAINT
CRIME/OTHER VIOLATION

CONTACT INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Home Phone

Mobile Phone

SUMMARY OF INCIDENT

Gaming Establishment where Incident Occurred:

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Where did the incident occur?

Table
Slot Machine

Table/Slot Machine Number

Location Number

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Date of Incident:

Approximate Time of Incident:

CASINO EMPLOYEES INVOLVED:

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Name

Name 3

Name 2

Name 4

WITNESS(ES) NAME(S) AND ADDRESS(ES)

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Witness Name

Witness Name 2

Witness Address

Witness Address 2

Describe in as much detail as possible the nature of incident, whether you reported this to the VI Casino Control Commission, the gaming facility’s security, or another authority, and if so, how they responded to the incident.

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Signature

Clear Signature

Date

What's the answer?

VICCC

Patron Disputes & Complaints

CONTACT INFORMATION

SUMMARY OF INCIDENT

CASINO EMPLOYEES INVOLVED:

WITNESS(ES) NAME(S) AND ADDRESS(ES)

VICCC

Contact

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