Win/Loss Request Forms - Play Like A Rebel | New Hampshire Win/Loss Request Forms - Play Like A Rebel | New Hampshire


Please utilize the provided forms below to inquire about a Win/Loss or W2G Statement. If you have achieved a taxable jackpot in the year, you would have received Form W2G-1099 at the time of winning. The required documents should be printed, filled out manually, or submitted via mail or in person. Ensure that all fields are completed, and allow 30 days for the processing of your request.

Mailing address:
New Hampshire Group, LLC
Attn: Finance Department
887B Central Ave
Dover, NH 03820

Legal Disclaimer
By submitting a request for either a Win/Loss statement or W2G, you acknowledge that Peninsula Pacific Entertainment New Hampshire Group, LLC shall not be responsible if you do not receive the requested information. In the event that the information provided by you has changed or no longer matches the information on file, we may be unable to satisfy your request. Please contact Peninsula Pacific Entertainment New Hampshire Group, LLC if you need to change your information.
Win/Loss Request
This is not a tax document. By submitting this form you acknowledge and agree that you are requesting a Win/Loss Statement that will include estimated gaming Win/Loss information. The tracking system used in providing this information is based upon the terms and conditions and use of your Players Club card. Therefore, this statement will not reflect an accurate accounting record – it merely provides an unverified, estimate for comparison to your records. This is not a substitute for records required by you for applicable State or Federal tax laws.

Furthermore, by submitting this form, you certify that the information inputted above is true and correct, and authorize Peninsula Pacific Entertainment New Hampshire Group, LLC to provide a Win/Loss Statement of tracked gaming activity for your Players Club membership. You further understand that the information requested is generated from a guest’s tracking system based upon Players Club account history and is not intended to be, or take placed of, your own records of your gaming activity. Peninsula Pacific Entertainment New Hampshire Group, LLC makes no representation or warranty, expressed or implied, as to the accuracy of this information or its effectiveness as proof of winnings and losses.
W2G Request
A request for W2Gs is a request for copies of all IRS form W-2G/1099s issued to you. This is not a request for a complete accounting of your play. For additional information on the Form W-2G and its instructions, visit

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