Enter Receipt Value:
Enter Chip Quantities:
Black = $5
Blue = $20
Red = $50
Green = $100
Gold = $500
Residency:
- Choose One - USA (Guam included) CNMI (Saipan, Tinian) Foreign (International)
Social Security Number:
Receipts Total:
Receipts Entered:
Chip Quantity:
Winnings:
Chip Value:
Tax Withheld:
Cash Out: