AUTHORIZATION FORM

I certify that the electronic media record of my transaction held by Party City Casino shall be used as the final determination to resolve any dispute I may have. I clearly understand it is my sole responsibility, if applicable, to report my financial information to my respective Government, Customs, or Tax jurisdiction. I acknowledge that I have read all the information contained in Party City Casino license and agree to follow by all the rules, terms, conditions, and agreements therein and as amended from time to time.

(Please clearly complete ONE form, including every Credit Card you have used to deposit with Party City Casino.)


After the form is completed and signed, and all necessary documents are attached, send to:

Toll Free Fax #: 800-992-4778
Send Scanned Copies: ccprocessing@partycitycasino.com.
Customer Service, Toll Free #: 1-800-684-1300

Please remember to sign the form by hand. * Information Required.


PARTY CITY CASINO ACCOUNT VERIFICATION FORM:

ACCOUNT VERIFICATION and TRANSACTION ACKNOWLEDGEMENT FORM :

    1. I, _________________________(NAME OF CUSTOMER), alias _______________________________________do certify that the electronic media record of my transaction held by BTK Ltd and its affiliates shall be used as the final determination to resolve any dispute I may have. I clearly understand it is my sole responsibility, if applicable, to report my financial information to my respective Government, Customs, or Tax jurisdiction.

    2. I acknowledge that I have read all the information contained in their license and agree to follow by all the rules, terms, conditions, and agreements therein, and as amended from time to time.

    3. I acknowledge that I am the legal card holder of the following credit card:

Credit Card: ________________________exp date: ________

Credit Card: ________________________exp date: ________

Credit Card: ________________________exp date: ________

Billing address: _______________________________________________________________________________________________________

    For verification purposes, I am sending a visible copy of my driver's license or other form of official photo I.D. as well as a copy of each credit card used and copy of a Utility Bill (phone bill, electricity bill) for address verification.

Signature: ______________________________________ Signature/Initials: _______/_______/_______

After the form is completed and signed, and all necessary documents are attached, send to:

Toll Free Fax #: 800-645-9708
Send Scanned Copies: ccprocessing@partycitycasino.com
Customer Service, Toll Free #: 1-800-684-1300

Please remember to sign the form by hand.