(Please clearly complete ONE form for every Credit Card you have used to deposit If it applies)

After the form is completed and signed, and all necessary documents are attached, fax to: Toll free fax number: 1-888-879-1302 or send scanned copies to ccprocessing@coolcatcasino.com For Customer Service, Toll free number: 1-888-441-6693, International 1-678-349-0349. Please remember to sign the form by hand. * Information Required.

COOL CAT ACCOUNT VERIFICATION FORM

ACCOUNT VERIFICATION and TRANSACTION ACKNOWLEDGEMENT FORM

I, _______________________________Name of Customer, alias _________________, do certify that the electronic media record of my transaction held by Emoney Processing Ltd. and its affiliates shall be used as the final determination to resolve any dispute I may have. I clearly understand it is my sole responsibility, if applicable, to report my financial information to my respective Government, Customs, or Tax jurisdiction.

I acknowledge that I have read all the information contained in their license and agree to follow by all the rules, terms, conditions, and agreements therein and as amended from time to time.

I acknowledge that I am the legal card holder of the following credit card:


Credit card _____________________________________ exp date:

Credit card _____________________________________ exp date:

Credit card _____________________________________ exp date:

Billing address: ____________________________________________________________

____________________________________________________________


For verification purposes, I am sending a visible copy of my driver's license or other form of official photo I.D. as well as a copy of each credit card used and copy of a Utility Bill (phone bill, electricity bill) for address verification.
 

Signature: __________________________ Date: _______________________

after the form is completed and signed, and all necessary documents are attached, fax to: Toll free number: 1-888-879-1302 or send scanned copies to ccprocessing@coolcatcasino.com. For Customer Service, call: 1-888-441-6693. Please remember to sign the form by hand.