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Get Egm Cashless Verification Submission Form - Mississippi Gaming ...

Ty: State: Zip Code: Contact Person: Position / Title: Phone # Fax # E-mail: Mississippi Manufacturer and/or Distributor License Number: SUBMISSION INFORMATION (Complete all applicable items.) Submission Type: New: Upgrade: Modification: Authorized MGC testing facility receiving submission: Name of EGM Hardware Platform: Version # Name of EGM Game: EPROM (or equivalent) identifier: Software version: Firmware version: Device Type: Device Position: CRC: Ticket Printer Type: Ticket Printer Firmware.

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