Contact Form

Section I. Business information

Company Information

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Section II. Business Biography

Company Data

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Diversity Information

License and Regulatory Information


Products and/or services classifications

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This product profile section enables you to define the types of goods and services your company provides in more detail. The information entered here will be accessed by Penn National Gaming Inc. buyers using a "keyword browse" feature. Please use this section to help us easily identify your company during the sourcing process.

Select the following Penn National Gaming INC. Properties you are currently, or are interested in, doing business with:



Authorized Company Representative Acknowledgement and Signature

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By choosing to submit this form, you certify that all the information is true and accurate. Any misrepresentation of your company on this or any other form submitted, will result in our disqualifying your company from doing business with Penn Gaming Corporation, and it's affiliates. Additionally, submission of this form does not automatically guarantee you future business.