To Platinum Reels casino, 

My Casino Username/Login: ______________________

I (First name and last name)_____________________________________________ confirm all transactions on my casino account were authorized and executed by me in my personal capacity.

I have read and agree to the casino’s current terms and conditions and understand that such records may be used to resolve any disputes which I may have whether present or forthcoming.

I registered the following payment card details at Platinum Reels and honor all purchases.

(Please enter only the first 6 and last 4 digits of the card in the spaces provided below):

First 6 card digits
Last 4 Card digits


First 6 card digits
Last 4 Card digits


First 6 card digits
Last 4 Card digits


First 6 card digits
Last 4 Card digits


First 6 card digits
Last 4 Card digits


First 6 card digits
Last 4 Card digits


I hereby confirm to have read and acknowledge the terms of this agreement and hereby wish to accept and confirm this declaration as authorization for all current purchases made at Platinum Reels:

Signature: _________________________ Date: ______/_______/_______ (MM/DD/YYYY)

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