000-000-0000 or (000) 000-0000
Date of request
I request that Rock & Brews Casino provide me with a win/loss statement and or W2g from its Braman property or KGI's former Newkirk property. In consideration for this information, I hereby release the Kaw Nation, Rock & Brews Casino and their affiliated companies, and all claims respective owners, officers, directors, managers, employees, representatives and agents from any and all claims arising from or relating to the information and its release, and further agree to indemnify and hold those entities and persons harmless from any such claims. I understand that the information requested is generated from internal marketing records and is not intended to be or take place of my own records of gaming activity. Furthermore, I voluntarily consent to the jurisdiction of the Kaw Nation. Rock & Brews makes no representation or warranty, express or implied, as to the accuracy of this information or its effectiveness of proof of losses. This is not a valid tax document. It is for information purposes only.
Please attach valid form of ID with Submission. (Required) (pdf, doc, docx):
