Credit Application Chumash Casino Resort


*  Indicates field is required
Personal Information

Personal Information



ft in
lbs
cm
kg

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
$
$
$
$
$
Primary Bank Information

Bank Account #1

Pre-paid debit cards, credit cards, trust, charitable, or multiple signer accounts are not valid options.
 * Applicant must be the sole proprietor of this account
Secondary Bank Information

Bank Account #2

Pre-paid debit cards, credit cards, trust, charitable, or multiple signer accounts are not valid options.
 * Applicant must be the sole proprietor of this account


Gaming Information Other Casino Credit

Gaming Information Other Casino Credit

$
$
$


License Agreement

I certify that I have reviewed all information above and it is accurate. I authorize Chumash Casino Resort & Spa and its agents to conduct such investigations pertaining to information, as it deems necessary for the approval of my credit limit and to furnish information concerning such credit record to credit reporting agencies and others who may properly receive this information. I am aware an application is required to be prepared by the regulations of the Chumash Casino commissions and I may be subject to civil and criminal liability if any material information provided by me is willfully false. With respect to the collection of my debt I agree to submit to the jurisdiction of any state of federal court in California and I agree to pay all cost of collection, including Chumash attorney fees and court costs, in addition to any amounts authorized by law.

I herby authorize Chumash Casino Resort and its Agents to retain and apply any and all jackpots, chips, or winnings first to the reduction of any outstanding credit balance with the remainder, if any returned to me. I agree to authorize the Chumash Casino Resort to charge any unpaid casino debt to any credit cards that the undersigned has presented to the Chumash Casino Resort for any purpose. I also agree that the Chumash Casino Resort may deposit any markers into the accounts listed above at any time and that the funds will be made available so that they will clear upon presentation.

Privacy Policy

Click here to view the Chumash Casino Resort Privacy Policy.

Click here to view the Privacy Policy for National Cred-A-Chek, Inc.

Signature

I, the undersigned, hereby authorize and instruct Chumash Casino Resort and its agent National Cred-A-Chek, Inc. ("NCC") 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 credit application 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 Chumash Casino Resort, NCC 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 NCC 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.

National Cred-A-Chek, Inc. ("NCC") 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 National Cred-A-Chek, Inc. 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.