NORTH CAROLINA STATE LOTTERY COMMISSIONFile A Complaint

NORTH CAROLINA STATE LOTTERY COMMISSION

File A Complaint

FILE A COMPLAINT

Important:

• North Carolina State Lottery Commission’s goal is to ensure public confidence in the integrity of gaming and to provide strong oversight of sports wagering in the State. Commission staff will review your submission to ensure wagering licensees are complying with the law, Commission rules, and their internal controls and house rules. If appropriate, the Commission will take regulatory enforcement action in the manner dictated by the circumstances and the governing law.

• The information requested on this form is necessary to properly investigate your complaint. Please fill it out entirely to the best of your ability.

• The information you provide to the North Carolina State Lottery Commission on this form may become public record.

• A copy of the information provided in this complaint form may be shared with the licensee complained against.

• A copy of the information provided in this complaint form may be shared with law enforcement, as necessary.

• The Commission cannot provide you with legal advice or bring legal action on your behalf. You may wish to consult a private attorney regarding this incident to evaluate any legal remedies that may be available to you.

Contact Information

Full Name (First, Middle, Last)*

Street Address or PO Box*

City*

State*

Select

Zip Code*

Home Phone

Phone

Mobile Phone

Phone

Email*

Summary of Dispute

Licensee(s) Complained Against (if known or applicable)*

Select or enter value

Other

Enter any entity not listed

When did this incident occur?*

Please enter date

Approx. Time of Incident*

Location of Incident*

Select

Username

Account_ID

Place of Public Accommodation (physical wagering location)

Cashier or Kiosk Involved

Incident Description*

Provide a detailed written statement describing the incident. Be sure to clearly state your complaint. Include whether you reported the incident to the Operator or any other authority. If you reported it to the Operator, describe how they responded to your complaint. Include the name and contact information of any witnesses to the incident.

Have you consulted an attorney regarding your dispute?*

Select

Attorney Name

Attorney Phone Number

Phone

Attorney Email Address

Is there a pending or completed lawsuit regarding your dispute?*

Select

Electronic Signature - Please Type your Full Name

By typing your name below, you acknowledge that this is considered an electronic signature and you hereby attest that the foregoing information is true and accurate.

Send me a copy of my responses

Privacy Notice|Report Abuse