Credit Application Four Winds Casino


*  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, and trust 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, and trust 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 authorize the Pokagon Gaming Authority d/b/a Four Winds Casino Resort, Four Winds Hartford, Four Winds Dowagiac and Four Winds South Bend ("Four Winds") and its agents to conduct such investigations and to request from third parties such information relating to my creditworthiness as it deems appropriate in connection with my application for credit, and I authorize Four Winds to furnish information concerning my credit record with Four Winds to credit reporting agencies and others who may properly receive this information. I specifically authorize Four Winds to obtain a Credit Report, report regarding my gaming activity and any information regarding my bank accounts relating to me, in order to evaluate my creditworthiness. I am aware a credit application is required in order for Four Winds to extend credit to me, and that I may be subject to civil and criminal liability if I willfully provide false information. With respect to the collection of my account(s): (1) I agree to submit to the jurisdiction of the Pokagon Band of Potawatomi Indians Tribal Court and (2) I agree to pay all costs of collection, including investigator and attorney fees and court costs, in addition to any amounts authorized by law. I hereby authorize Four Winds 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 or paid to me as appropriate. I acknowledge that I am 21 years of age or older. I authorize Four Winds to complete any of the following missing items on any Marker or similar credit or payment instruments: (1) name of payee, (2) any missing amounts. (3) date (4) name, account number, and/or address and branch of any banks and financial institutions, and (5) any electronic encoding of the above items. This information can be for an account I own and from which I now or at some point in the future have a right to withdraw funds from without someone else’s approval, regardless of whether that account now exists or whether I provided the information on the account to Four Winds. I acknowledge that irrespective of any currency exchange laws in the country in which I reside, I have the ability and intent to legally repay any advance of money made to me by Four Winds. WARNING: A credit or payment instrument (including but not limited to Markers) is the legal equivalent of a personal check. Willfully drawing or passing a credit instrument and subsequent failure to pay such credit instrument with the intent to defraud, including knowing that there are insufficient funds in an account upon which it may be drawn, is a crime under Tribal and other law and may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt. I represent that at the time I sign any Marker, I have on deposit on any account which I have drawn a marker, sufficient funds on which I am an authorized signatory for all purposes, without restriction, funds sufficient to pay such Marker upon demand or presentment. I further agree that each Marker I sign is a separate transaction and credit instrument. If I receive the funds before I execute a Marker, I will promptly sign a Marker when presented to me in the amount of the funds I received. I declare and affirm that the information set forth above is t rue and accurate to the best of my knowledge and belief.

Privacy Policy

Click here to view the Privacy Policy for Four Winds Casino.

Click here to view the Privacy Policy for VisuaLimits, LLC

Signature

I, the undersigned, hereby authorize and instruct Four Winds Casino and its agent VisuaLimits, LLC ("VL") 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 Four Winds Casino, VL 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 VL 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.

VisuaLimits, LLC ("VL") 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 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.