Hard Rock Hotel & Casino Atlantic City

Front Money Application Hard Rock Hotel & Casino Atlantic City

Language

* Indicates field is required

Personal Information

First Name *

Middle Initial

Last Name *

Suffix

AKA

Gender *

Are you applying for someone else? *

First and Last Name *

Country *

Address *

Years at Address *

Main Phone *

Other Phone

Email Address *

Preferred Contact Method *

Send Mail to *

Country

Address *

Statements Sent To *

Social Security # Social Insurance # (SIN) International ID

Date of Birth *

Country of Birth *

Mother's Maiden Name *

Spouse's Name

Driver's License # * **

Expiration * **

Passport #

Country

Expiration

Height * ft in

Weight * lbs

Height * cm

Weight * kg

Hair Color *

Eye Color *

Do you wear glasses? *

** You must provide a Passport or Driver's License

** International Applicants must provide a Passport or International ID

Trip Information

Referred by (if not referred, enter N/A) *

Player # (if applicable) *

Reservation # *

Arrival Date *

Trip Occasion *

Deposit Amount *

Employment Information

Employer / Name of Firm Name of Your Business Previous Employer *

Type of Business *

Number of Years *

Position *

Annual Income *

Business Phone *

Fax *

Country *

Business Address *

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

Insider of Public Company *

Politically Exposed Person/Relative or Associate *

See PEP definition

Domestic PEP

A domestic PEP is a person who holds — or has held within the last 5 years — a specific office or position in or on behalf of the Canadian federal government, a Canadian provincial government, or a Canadian municipal government, for example:

Governor General, lieutenant governor or head of government;
member of the Senate or House of Commons or member of a legislature;
deputy minister or equivalent rank;
ambassador, or attaché or counsellor of an ambassador;
military officer with a rank of general or above;
pesident of a corporation that is wholly owned directly by Her Majesty in right of Canada or a province;
head of a government agency;
judge of an appellate court in a province, the Federal Court of Appeal or the Supreme Court of Canada;
leader or president of a political party represented in a legislature; or
ayor, reeve or other similar chief officer of a local government (municipal governments include cities, towns, villages and rural (county) or metropolitan municipalities).

Foreign PEP

A foreign PEP is a person who holds or has held one of the following offices or positions in or on behalf of a foreign state:

head of state or head of government;
member of the executive council of government or member of a legislature;
deputy minister or equivalent rank;
ambassador, or attaché or counsellor of an ambassador;
military officer with a rank of general or above;
president of a state-owned company or a state-owned bank;
head of a government agency;
judge of a supreme court, constitutional court or other court of last resort; or
leader or president of a political party represented in a legislature.

HIO

The head of an international organization is a person who is either:

the head of an international organization established by the governments of states; or
the head of an institution established by an international organization.
an international sports organization.

When we refer to the head of an international organization or the head of an institution established by an international organization, we are referring to the primary person who leads that organization, for example a Managing Director, Director-General, President, CEO etc.

Marijuana Related Source of Income *

Source of Income *

Investments Held With *

Pension Employer *

Savings Location *

Name of Spouse *

Other Source of Income *

Total Assets *

Source of Wealth *

Estimated Annual Compensation *

Estimated Total Annual Income *

Estimated Tax Bracket *

Estimated Liquid Net Worth *

Estimated Total Net Worth *

Total Amount of Indebtedness *

Source of Debt *

Mortgage/Loan Amount *

Credit Card Amount *

Other Amount *

Form of Funds *

Source of Funds *

* I understand that the casino may request documentation verifying the source of my funds. I agree to provide such documentation if requested and certify that all information provided in this application is true and accurate.

Gaming Information Other Casino Front Money

Do you have Front Money at other casinos? *

Please provide at least one casino where you have credit
If you do not see the casino listed, select 'Other' and enter the casino name in the space provided

Casino *

Country

Limit

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Casino

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Do you have credit at a Caesars Entertainment property utilized within 18 months?

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Signature

Date

License Agreement

I am aware that this application is required to be prepared, and that I may be subject to civil or criminal liability if any material information provided by me is willfully false. I am aware that the above information may be submitted to third parties for review and/or investigation for validation purposes. I have reviewed and attest to the accuracy of the information provided by me and contained in this application. I understand that further information may also be requested from me in the future for review and/or investigation for validation purposes for maintaining my account. Boardwalk 1000, LLC (dba Hard Rock Hotel & Casino Atlantic City) does not disclose any information about its guests or former guests to anyone except as permitted by law.

Privacy Policy

Click here to view the Hard Rock Hotel & Casino Atlantic City Privacy Policy.

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

* I acknowledge that I have read and accept the above privacy policies

Signature

I, the undersigned, hereby authorize and instruct Hard Rock Hotel & Casino Atlantic City and its agent NRT Technologies, Inc. and VisuaLimits, LLC. ("NRT") and its affiliates to aggregate report data in order to evaluate my front money 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 Hard Rock Hotel & Casino Atlantic City, NRT or its affiliates to verify such information through any source and to report any information to another casino, 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 front money 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 front money, 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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Signature

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