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Estate Checking Application


 Legal Estate Name*








Is the business involved in or does it have an
income stream generated from internet gambling?*




Identification Information    Why am I being asked for this information? USA Patriot Act.


First Name

Middle Initial


Last Name

Home Phone

Email Address


Tax ID No




Type of Identification

Other Identification Type

Issued By


Issue Date


Expiration Date

Other Information

Additional Comments


Please enter the words you see in the box, in order and separated by a space. Doing so helps prevent automated programs from abusing this service. If you are not sure what the words are, either enter your best guess or click the reload button next to the distorted words for a new set.