NORTH CAROLINA STATE LOTTERY COMMISSION

Report Dispute Form

 

REPORT A WAGER DISPUTE

Important:

•    Please be advised that the Commission is unable to act as a mediator to resolve wager disputes, make final decisions concerning wager disputes, or order monies be paid or refunded to you.


•    North Carolina State Lottery Commission’s goal is to ensure public confidence in the integrity of gaming and to provide strong oversight of wagering in the State. Commission staff will review your wager dispute to ensure licensed Operators 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.


•    Before filing this report with the Commission, you must exhaust all resolution procedures with the Operator with whom you are in dispute.


•    The information requested on this form is necessary to properly review your dispute. 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 report may be shared with the Operator with whom you are in dispute.


•    A copy of the information provided in this report 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 dispute to evaluate any legal remedies that may be available to you.

 

 

Contact Information

 
 
 
 
Phone
 
Phone
 
 

 

Summary of Dispute

 

Operator with whom you are in dispute

 
 
mm/dd/yyyy
 
 
 
 

Provide a detailed written statement describing the dispute. Include the name and contact information of any relevant witnesses.

 
 
 
mm/dd/yyyy
 

Provide a detailed description of the Operator’s response and efforts to resolve the dispute. Include a description of the type of relief or action you would like the Operator to take to address the dispute.

 
 
 
 

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.