Payment
Verification Form

Please return the following form along with the identification documents listed below:

Photo of ID (back and front in color);
Photo of the credit card used (back and front in color). The Company requires only the first 6 and last 4 digits, the expiration date, the card holder's name, and the signature (optional).;
Card verification form for each card used for deposits;
Utility bill (or any other official document, containing player's current physical address and full name on it), issued within 3 (three) months.

Documents to be submitted via email: [email protected]

Bank Name State of the issuing bank Acct. Holder's Name Account Number

ABA Routing Nº for wire transfer ACH Routing Nº for Paper and Electronic Transfers

Branch Code (NZ) SWIFT/BIC Code BSB Number (AU/NZ) Bank/sort code (Canada/UK/NZ) Transit ID (Canada) IBAN Number (Europe) Bitcoin Wallet Address (not Cash App)

* Please be informed that a copy of the voided check is needed for bank details validation (optional).

All withdrawal requests must first be reviewed and approved by the casino finance department before being sent for payment.

We record and store all interactions between the customers and the company. This record shall be used in case a dispute arises between the customer and Exclusive as a guarantee of its successful resolution. Please note that Exclusive is not liable for the accuracy of the beneficiary detail submitted in the form. By placing the signature below, you therefore acknowledge the credibility of the information provided and agree to act in accordance with the Terms and Conditions.

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Payment Verification Form

Payment
Verification Form