Rising Star Casino Resort - Credit Application

Credit Application Rising Star Casino Resort

* 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 * (US applicants only)

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, savings, trust, and loan accounts 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, savings, trust, and loan accounts 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 *

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?

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Signature

Date

License Agreement

I certify that I have reviewed all information provided and that it is true and accurate. I authorize Gaming Entertainment (Indiana) LLC, which is a wholly owned subsidiary of Full House Resorts, Inc, and its officers, directors, employees and agents ("Rising Star Casino Resort") to conduct such investigations pertaining to the above information as it deems necessary to comply with Rising Star's credit policies and procedures and or the regulations of the Indiana Gaming Commission.

I hereby authorize Rising Star 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 for the approval and maintenance of my credit account. Credit limits may change at any time, at the sole discretion of Rising Star. I understand that I may be subject to civil or criminal liability if I knowingly provide false, inaccurate, or misleading information.

I hereby authorize Rising Star within its sole discretion, to apply any & all chips. Tito tickets I may redeem, or jackpots I may win first to the reduction of any outstanding credit balance, with the remainder, if any, to be returned to me. I further acknowledge that Rising Star, in it's sole discretion, will determine the number of days negotiable instruments will be held.

In the event legal action is brought by Rising Star or its agents against me to collect any amounts owed by me to Rising Star, I further agree that I will be responsible for all costs associated with collection efforts, including but not limited to attorney fees incurred through collection process. Rising Star may, at any time, charge a service fee for any check return. This credit agreement and subsequent credit transactions shall be construed according to Indiana law and exclusive venue shall be in the courts of Ohio County in the State of Indiana.

Privacy Policy

Click here to view the Rising Sun Casino 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 Rising Star Casino Resort 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 Rising Star Casino Resort, 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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Signature

Date