Please fill out the information below in order to receive your Win/Loss Statement from Jackpot Junction Hotel & Casino’s Rewards Club. The Rewards Club will mail the requested reports directly from Jackpot Junction within two weeks.

Rewards Card Number(*)
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First Name(*)
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Last Name(*)
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Date of Birth(*)
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Address(*)
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City
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State(*)
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Zip Code(*)
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Year Requested(*)
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Important: By checking the “Agree” box above, the patron identified in this form hereby releases Jackpot Junction Casino Hotel an enterprise of the Lower Sioux Indian Community, its owners, employees, agents and/or assigns, and its parent and affiliated companies for, from and against any loss, cost, expense, damages, liability or claims of any kind. The patron identified in this form further acknowledges that the information is being provided: Is associated with player tracking information only No assurance is made that this activity was accumulated by the patron identified in this form The information may not be all inclusive of the patron identified in this form’s gaming activity and only reflects information currently available in Jackpot Junction’s Rewards Club database. 

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