<TABLE cellSpacing=0 cellPadding=0 width=640 bgColor=#ffffff border=0><TBODY><TR><TD>Anyone do this ??
The benefit is ??
Sure is a lot of personal info.
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Preferred Player Application Form
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</TD></TR><TR><TD><TABLE cellSpacing=0 cellPadding=10 width=630 border=0><TBODY><TR><TD>I, the undersigned, declare and confirm that the attached is a true copy of my original passport or drivers license and belongs to me. By signing below, I am authorizing you to gather information about me from my bank, credit bureaus and others to verify my identity and to determine my eligibility for credit, renewal of credit, and future extensions of credit.
To process this form, it must be accurately completed and verifiably correct.
First Name: _______________Last Name:_____________________
Phone: (____) _______ - __________ Fax: (____) _______-__________ (optional)
EmpirePoker Account Name: __________Date of Birth: ______/_____/_____
MM / DD / YY
Social Security Number (or Foreign Equivalent): ____________________________
Credit Card and Checking Account Information
Credit Card No.: ___________________________ Expiration Date: _____/_____
Checking Account Number:_______________________________
Billing Address
Street Address: ____________________________________________________
City: _____________________________ State:__________________________
Country: __________________________ Zip Code:_______________________
</TD></TR><TR><TD>______________________________________ Date: _____/_____/______
Signature MM / DD / YY
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Please attach a copy of the front and back of your credit card, a voided check and your government issued identification (either a driver's license or passport).
Please mail this form and related documents to:
WPC Productions
c/o International Mail Forwarding
4410 West, 16th Avenue, #5-178
Hialeah, Florida 33012, USA
</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
The benefit is ??
Sure is a lot of personal info.
========
Preferred Player Application Form
</TD></TR><TR><TD align=middle>
To process this form, it must be accurately completed and verifiably correct.
First Name: _______________Last Name:_____________________
Phone: (____) _______ - __________ Fax: (____) _______-__________ (optional)
EmpirePoker Account Name: __________Date of Birth: ______/_____/_____
MM / DD / YY
Social Security Number (or Foreign Equivalent): ____________________________
Credit Card and Checking Account Information
Credit Card No.: ___________________________ Expiration Date: _____/_____
Checking Account Number:_______________________________
Billing Address
Street Address: ____________________________________________________
City: _____________________________ State:__________________________
Country: __________________________ Zip Code:_______________________
</TD></TR><TR><TD>______________________________________ Date: _____/_____/______
Signature MM / DD / YY
</TD></TR><TR><TD align=middle>
Please attach a copy of the front and back of your credit card, a voided check and your government issued identification (either a driver's license or passport).
Please mail this form and related documents to:
WPC Productions
c/o International Mail Forwarding
4410 West, 16th Avenue, #5-178
Hialeah, Florida 33012, USA
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