Customer Service Agreement Ameristar Casino Hotel Vicksburg

Applying for

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Personal Information

Personal Information






* **

ft in
lbs
cm
kg
** You must provide a Passport or Driver's License
** International Applicants must provide a Passport or International ID
Trip Information

Trip Information

$

Employment Information

Employment Information

$

New Jersey Gaming Declaration

Are you a gaming related casino employee, a state officer or employee, member of judiciary or legislature, or an officer of a municipality or county in New Jersey?


Financial Information

Financial Information
$
$
$
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Primary Bank Information

Bank Account #1

Pre-paid debit and credit cards are not valid options.
 * Applicant must be the sole proprietor of this account
Secondary Bank Information

Bank Account #2

Pre-paid debit and credit cards are not valid options.
 * Applicant must be the sole proprietor of this account


Gaming Information Other Casino Credit

Gaming Information Other Casino Credit




Customer Service Agreement

I give AMERISTAR CASINO VICKSBURG, INC. ("AMERISTAR") and its representatives authorization to obtain and verify my financial information (including but not limited to account balance information) from any source, obtain my financial and employment history and exchange information with others about my financial and account experience with AMERISTAR. I agree not to hold any of the entities responsible or liable for the information released, nor AMERISTAR for its use of any such information. I agree that AMERISTAR may retain and use information on this application and any information it receives based on my authorization whether or not I am granted marker signing privileges.

As a condition to being granted marker signing privileges, I agree to sign credit instruments, aka markers or checks (hereinafter “markers”) in the amount of the funds (e.g. chips, cash, tokens, etc.) issued to me. Further, I authorize AMERISTAR to complete any of the following information on those markers: (1) name of payee, (2) a date, (3) name, account number, and/or address of any of my banks and financial institutions, (4) electronic encoding of the above and (5) as otherwise authorized by law. The information inserted may be for any account from which I now or may in the future have the right to withdraw funds, regardless of whether that account now exists, and whether I provided the information on the account to AMERISTAR. I REPRESENT THAT AT THE TIME I SIGN ANY MARKER, I HAVE ON DEPOSIT IN ACCOUNTS ON WHICH I AM AN AUTHORIZED SIGNATORY FOR ALL PURPOSES, WITHOUT RESTRICTION, FUNDS SUFFICIENT TO PAY SUCH MARKER UPON DEMAND OR PRESENTMENT.

I agree that each marker I sign is a separate transaction. If I receive the funds before I execute a marker, I promptly will sign a marker when presented to me, in the amount of the funds I received.

I agree that Mississippi law exclusively applies to these transactions, that the exclusive jurisdiction for any dispute arising out of or related to any of the above shall be a state or federal court sitting in Hines County, Mississippi and that I waive any requirement of presentment.

In addition to any amounts authorized by law, I will pay all costs of collection, including reasonable attorney’s fees and court costs.

I agree that the information set forth above is true and accurate to the best of my knowledge.

I hereby authorize Ameristar Casino Vicksburg to investigate my credit record and to furnish information concerning such credit record to credit reporting agencies and others who may properly receive this information.

I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize Ameristar Casino Vicksburg to conduct such investigations pertaining to the above information as it deems necessary for the approval of my credit limit. I am aware that this application is required to be prepared by the regulations of the Mississippi Gambling Commission and I may be subject to civil or criminal liability if any material provided by me is willfully false.

Privacy Policy

Click here to view the Privacy Policy for Ameristar Casino Hotel Vicksburg.

Click here to view the Privacy Policy for NRT Technologies, Inc. and VisuaLimits, LLC

Signature

I, the undersigned, hereby authorize and instruct Ameristar Casino Hotel Vicksburg and its agent NRT Technologies, Inc. and VisuaLimits, LLC. ("NRT") and its affiliates to obtain consumer reports, to contact financial institutions, and to check my consumer credit, employment, bank and gaming history in order to evaluate my customer service agreement as well as to update and/or review my account to provide services requested by me, as necessary or as required by law. I authorize Ameristar Casino Hotel Vicksburg, NRT or its affiliates to verify such information through any source and to report any information to another casino, excluding credit report data obtained from a credit agency, and to exchange any information with any of the affiliates of the Company. I hereby release and waive, and agree not to bring at any time in the future, any claims or demands against NRT or its affiliates relating to any credit investigation made pursuant to my authorization and instructions herein, including, without limitation, the collection, processing, and transmission of my information and data.

NRT Technologies, Inc. and VisuaLimits, LLC. ("NRT") promotes responsible gambling. By entering my name in the signature field and clicking the "I Accept" button below, I acknowledge that I have read the NRT Technologies, Inc. and VisuaLimits, LLC. Responsible Gaming Policy.

By entering my name in the signature field and clicking the "I Accept" button below, I hereby represent, warrant, and agree that all information provided herein is true and correct, that I am the person for whom I am requesting credit, and that I have read, understand, and agree to be bound by all of the terms herein.

I hereby acknowledge and agree that this Application may be signed electronically and that such electronic signatures shall be deemed an original for all purposes. I represent and warrant that by signing this Application electronically or causing this Application to be signed electronically that I have the authority to do so and that such electronic signature shall be sufficient to bind the respective party under this Application.


Physical Signature


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