W2G Request

I hereby certify that the information and statements contained herein are true and correct. I hereby authorize Indigo Sky Casino & Outpost Casino, its officers, directors, employees, and agents from and against any loss, cost, expense (including attorney fees and costs), damages, liability, or claims of any kind. I agree to indemnify Indigo Sky Casino & Outpost Casino from and against any and all lawsuits, causes of action, liabilities, costs, losses, damages, and attorney’s fees and costs which I or my spouse, administrators, executors, agents, assignees, or any thid party may have arising out of or relating to this request.

Name(Required)

First Last

Player's Club Card Number(Required)

Primary Contact Phone Number(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Requesting from Property(s):(Required)

Indigo Sky Casino

Outpost Casino

Tax Year(Required)

Delivery Method(Required)

Mail

Personal Fax

In Person Pick Up

Please select only one.

W2G Request

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