| ACCOUNT VERIFICATION FORM. Please enter your username for each of our casinos that you hold and account with: |
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| WEBSITE | USERNAME |
|---|---|
| PALACE OF CHANCE | |
| Personal Information | |||
| Full Name: | |||
| Adress: | |||
| City: | State: | ||
| Zip Code: | Date of Birth: | ||
| Day Phone: | Evening Phone: | ||
| CARD NUMBER | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EXPIRY DATE (MM/YYYY) | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Legal Statement
I certify that the electronic media record of my transaction held by the EMONEY PROCESSING LTD. shall be used as the final determination to resolve any dispute I may have. I acknowledge that I have read all the information contained in the EMONEY PROCESSING LTD License and agree to abide by all the rules, terms, conditions and agreements therein and as may be amended from time to time.
I also certify that the credit cards listed above have been registered with the EMONEY PROCESSING LTD and used there with my full knowledge and consent.
| Signature | Date |
Return this completed and signed form to us along with a visible copy of your driver’s license or other form of official photo I.D. as well as a copy of each credit card used and a utility bill or bank statement with your printed address on.
We will accept these documents by fax or you can also take a digital photograph or scan them and email them to us.
Email: ccprocessing@palaceofchance.com or creditcards@casinosupportcenter.com
In you have any questions or concerns regarding how your credit card billing will appear, please feel free to send us an email or contact us to our Customer Service Live Help.
|
Make an imprint of your embossed credit card |
Use any of our US Toll Free Fax number:
1-800-880-6186 or 1-800-847-6197 or 1-888-879-1302 or 1-800-847-5125 or 1-866-369-0548 or 1-888-579-4555 or 1-866-308-6010