Credit Card Authorization Form

Personal information:
Full Name:
Address:
City:
 State:
ZIP Code:
 Date of Birth: / /
Day Phone:
 Evening Phone:

Silver Oak Casino Group - Account Information:
WEBSITE
USERNAME
WEBSITE
USERNAME
CAPTAIN JACK CAT'S EYE
GOLD STREAM LUCKY PALM
PHARAOH'S GOLD PLANET 7
RINGMASTER ROYAL ACE
SILVER OAK

Credit Card Information:
CARD NUMBER EXP. DATE (MM/YYYY)
/
/
/

Return with Copies of Your Credit Cards (Front & Back)

  • Scan or take a digital picture of your valid State or Federal ID (i.e. Driver's License or Government Issued ID) along with the credit cards you have used, or plan to use, with our clients (front and back of all cards, including ID's is required).
  • We will also require a recent utility bill or bank statement with your printed address on it.
  • Email or fax all of these copies back, along with this signed form, as soon as possible. You can email copies to accounting@pharaohsgoldcasino.com. If you prefer to fax, you can send them to any of the Toll Free fax numbers listed at the bottom of this form.

For more information on how your purchases will appear on your credit card statement, please feel free to send us an email or contact us via our Live Casino Support.

I Certify...

I certify that the electronic media record of my transaction held by the SILVER OAK CASINO GROUP 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 SILVER OAK CASINO GROUP 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 SILVER OAK CASINO GROUP and used there with my full knowledge and consent.

Signature: __________________________________ Date: / /

Please FAX this form back using any of the Toll Free FAX #'s below:
1-866-725-1126 / 1-866-725-1109 / 1-866-725-1103