Horsemen account disbursement request - Hollywood Gaming: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your ACCOUNT NUMBER in the designated field. Ensure that this number is accurate to avoid any processing delays.
Select the LEGAL STATUS OF ACCOUNT by checking the appropriate box for INDIVIDUAL, PARTNERSHIP, or CORPORATION.
Fill in the ACCOUNT NAME, along with your PHONE NUMBER and E-MAIL ADDRESS for contact purposes.
Enter the DATE of the request and specify the AMOUNT TO BE DISBURSED clearly.
Indicate whether this check should be MAILED 1ST CLASS or PICKED UP by selecting the appropriate option.
If applicable, provide details for AMOUNT TO BE TRANSFERRED and ensure it aligns with authorized accounts only.
Authorize the transaction by signing at the bottom of the form, confirming your identity as either OWNER or AUTHORIZED AGENT.

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