Please print and fax to: Sun Internet Services.

Toll Free Fax number: 1-888-203-7785 USA & CANADA only 
Toll Free Fax number: + 868-624-1156  ALL Other Countries

Date:

Member name: ____________________________          

Account name/number: ______________________ 

Address:______________________________________
               ______________________________________
               ______________________________________
               ______________________________________

I currently play at the casinos:

Online Casinos

1. _________________________________________________
2. _________________________________________________
3. _________________________________________________

1. _____________________________ City: _______________
2. _____________________________ City: _______________
3. _____________________________ City: _______________

I request my purchase limit is increased according to the amounts described here
and authorize Sun Internet Services. (1-888-349-7752) to charge ECash purchases to my
credit/debit card number/s as follows:
1. ________________________________ Expiry date: ________
2. ________________________________ Expiry date: ________
3. ________________________________ Expiry date: ________

$........ in any one day as I require.

$........ maximum for any refreshed period. I understand Sun Internet Services.
(1-888-349-7752) will be the name that will appear on my credit/debit card statement.

Signed: ____________________________
Date: _____________

Print name: (Mr / Ms)________________________________

For further information contact our support staff at support@goldgatecasino.com