Margaritaville Resort Casino - Credit Application

Credit Application Margaritaville Resort Casino

Language

Applying for

* 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 *

** 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 *

Credit Requested *

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 *

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 Funds *

Account #1

Pre-paid debit cards, credit cards, business accounts, and trust accounts are not valid options. are not valid options.

Branch Country

Financial Institution Type *

Bank Name Credit Union Name *

Bank Routing Number Credit Union Routing Number *

Brokerage Firm *

Account Number Checking Account Number *

Brokerage ID Member ID

Account Type *

* Applicant must be the sole proprietor of this account

Association with Business *

Is Account a Trust? *

Branch Address *

Bank Officer *

Phone *

Account #2

Pre-paid debit cards, credit cards, business accounts, and trust accounts are not valid options. are not valid options.

Branch Country

Financial Institution Type

Bank Name Credit Union Name

Bank Routing Number Credit Union Routing Number

Brokerage Firm *

Account Number Checking Account Number

Brokerage ID Member ID

Account Type

* Applicant must be the sole proprietor of this account

Association with Business

Is Account a Trust?

Branch Address

Bank Officer *

Phone *

Instant Bank Account Verification –
Speeds up approval!

If you want to speed up the approval process, click the Instant Verification button to complete the requested information and we will receive a read-only verification of your bank account status.

This is safe, secure, encrypted, and fast
You will need: bank login and bank account information
No bank login information is retained by the casino

Click on the accounts you would like to verify then click Proceed

Bank Name:
Routing Number:
Account Number:

Bank Name:
Routing Number:
Account Number:

The errors listed above need to be fixed before submitting Instant Bank Verifications for the selected accounts. Please return to the application and fix the errors

The following errors need to be fixed before submitting an Instant Bank Verification.

Please return to the application and fix the errors

Do you wish to be notified prior to deposit?

Gaming Information Other Casino Credit

Do you have Credit 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

Casino

Country

Limit

Casino

Country

Limit

Casino

Country

Limit

Casino

Country

Limit

Casino

Country

Limit

Casino

Country

Limit

Casino

Country

Limit

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

Sign Here

Signature

Date

License Agreement

I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize Bossier Casino Venture, Inc. DBA Margaritaville Resort Casino to conduct such investigations pertaining to the above information as it deems necessary for the approval and maintenance of my credit limit, including but not limited to obtaining a credit report from a national credit reporting agency. I am aware that this application is required to be prepared by the regulations of the Louisiana Gaming Control Board and the Riverboat Gaming Commission and I may be subject to civil or criminal liability if any material information provided by me is willfully false. I understand that the information provided by me to complete this application is provided for the purpose of inducing Bossier Casino Venture, Inc. to issue credit to me. I authorize Bossier Casino Venture, Inc. to conduct such investigations pertaining to the above information as it deems necessary in its sole discretion for the approval or rejection of my credit limit. I also certify that I am 21 years of age or older. I understand that Louisiana law prohibits persons under the age of 21 from engaging in gaming activity. Accordingly, I must be 21 years of age or older to apply for and obtain credit at Bossier Casino Venture, Inc. I am aware that false misrepresentation of my age on this application and/or my entry onto the casino floor if I am less than 21 years of age subjects me to criminal prosecution.I agree to pay all sums due as a result of credit extended, loaned, or advanced to me by Bossier Casino Venture, Inc. whether by way of chips, cash or checks within the time period determined as according to the guidelines set by Bossier Casino Venture, Inc. I further authorize Bossier Casino Venture, Inc. to debit any of the accounts listed above in repayment of any of the sums that are not paid on or before the due date following the time period as determined by Bossier Casino Venture, Inc. I agree that any partial payment on account of outstanding debt owing to Bossier Casino Venture, Inc. shall be deemed an acknowledgement by me of the total remaining balance of that outstanding debt. In the event an attorney is employed to collect the credit balance, I agree to pay the cost of such collection together with reasonable attorney fees.This agreement shall be governed by the laws of the state of Louisiana. For the purpose of any action for the enforcement or collection of any outstanding debt I owe or may owe in the future to Bossier Casino Venture, Inc. I hereby submit to the personal jurisdiction of the state and federal courts sitting in Bossier City, Parish of Bossier, State of Louisiana and I hereby waive any and all objections or exceptions I may have to (1) such courts’ lack of jurisdiction over my person and (2) improper venue.

I authorize Bossier Casino Venture, Inc., in its sole discretion, to apply any and all chips, cash or checks I may redeem, first, to the reduction of my outstanding credit balance with the remainder, if any to be returned to me.

Margaritaville Privacy Statement

* Please CLICK HERE to view the Margaritaville Resort Casino Privacy Statement before submitting the application.

Privacy Policy

Click here to view the Privacy Policy for Margaritaville Resort Casino.

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 Margaritaville Resort Casino 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 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 Margaritaville Resort Casino, 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

Sign Here

Signature

Date

Credit Application Margaritaville Resort Casino

Personal Information

Trip Information

Employment Information

Financial Information

Account #1

Account #2

Instant Bank Account Verification –
Speeds up approval!

Select an Account

You are currently verifying :

Gaming Information Other Casino Credit

License Agreement

Margaritaville Privacy Statement

Privacy Policy

Signature

Physical Signature

Credit Application Margaritaville Resort Casino

Personal Information

Trip Information

Employment Information

Financial Information

Account #1

Account #2

Instant Bank Account Verification – Speeds up approval!

Select an Account

You are currently verifying :

Click on the accounts you would like to verify then click Proceed

You are currently verifying :

Please complete all steps of the verification process.

When finished click the Finish button below.

Gaming Information Other Casino Credit

License Agreement

Margaritaville Privacy Statement

Privacy Policy

Signature

Physical Signature

Instant Bank Account Verification –
Speeds up approval!