Home Advanced Deposit Wagering Provider ACH Advanced Deposit Wagering Provider ACH Text field This payment page is only for Electronic Checks. To Make a payment using a Credit Card please use Credit Card Payments page. Customer Information Organization - Select -TVG / FanDuelTwin SpiresXpressbet First Name Last Name License / Customer / Vendor Number # Email @ Phone Number # Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code TVG / FanDuel Options TVG/Fan Duel Pari-Mutuel Taxes - R007 RWA - R007 Breeders Awards 5% - R007 Breeders Awards 1% - R007 Permits - R007 Investigative Fees for Permittees-R007 Racing Fines & Penalties-GF-R007 Racing Fines & Penalties 5% RHA-R007 Pari-Mutuel Taxes Pari-Mutuel Taxes Amount $ Race Date RWA RWA Amount $ Race Date Breeders Awards 5% Breeders Awards 5% Amount $ Race Date Breeders Awards 1% Breeders Awards 1% Amount $ Race Date Permits Amount $ Investigative Fees Amount $ Racing Fines & Penalties-GF Amount $ Name and Ruling # Racing Fines & Penalties 5% Amount $ Name and Ruling # Twin Spires Options Twin Spires Pari-Mutuel Taxes - R006 RWA - R006 Breeders Awards 5% - R006 Breeders Awards 1% - R006 Permits - R006 Investigative Fees for Permittees-R006 Racing Fines & Penalties-GF-R006 Racing Fines & Penalties 5% RHA-R006 Pari-Mutuel Taxes Pari-Mutuel Taxes Amount $ Race Date RWA RWA Amount $ Race Date Breeders Awards 5% Breeders Awards 5% Amount $ Race Date Breeders Awards 1% Breeders Awards 1% Amount $ Race Date Permits Amount $ Investigative Fees Amount $ Racing Fines & Penalties-GF Amount $ Name and Ruling # Racing Fines & Penalties 5% Amount $ Name and Ruling # Xpressbet Options Xpressbet Pari-Mutuel Taxes - R008 RWA - R008 Breeders Awards 5% - R008 Breeders Awards 1% - R008 Permits - R008 Investigative Fees for Permittees-R008 Racing Fines & Penalties-GF-R008 Racing Fines & Penalties 5% RHA-R008 Pari-Mutuel Taxes Pari-Mutuel Taxes Amount $ Race Date RWA RWA Amount $ Race Date Breeders Awards 5% Breeders Awards 5% Amount $ Race Date Breeders Awards 1% Breeders Awards 1% Amount $ Race Date Permits Amount $ Investigative Fees Amount $ Racing Fines & Penalties-GF Amount $ GF Name and Ruling # Racing Fines & Penalties 5% Amount $ Name and Ruling # Payment Detail Preview Leave this field blank