Report Bingo and Charitable Games Complaints Online Form

Please provide as much information as possible in the blanks below. You may remain anonymous if you wish.

Note: Anonymous complaints may not be able to be investigated.

* indicates required field

Name

Address

City

State

ZIP

Phone

E-Mail

Other Identifiers

(SSN, DOB)

Violator's Name

Violator's Address

Violator's City

Violator's State

Violator's Zip

Other Identifiers

(SSN, DOB)

Describe your complaint

Violators Business Information

Provide information regarding violator's business or employees (names, how they earn income, do they hide income, etc.)

File Attachment

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