Customer Service Agreement Boomtown Casino Hotel Bossier City

Applying for

*  Indicates field is required
Personal Information

Personal Information





* **

ft in
lbs
cm
kg
** You must provide a Passport or Driver's License
** International Applicants must provide a Passport or International ID

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 and credit cards are not valid options.
 * Applicant must be the sole proprietor of this account
Secondary Bank Information

Bank Account #2

Pre-paid debit and credit cards are not valid options.
 * Applicant must be the sole proprietor of this account


Gaming Information Other Casino Credit

Gaming Information Other Casino Credit




Customer Service Agreement

I agree to repay all sums that become due and owing by me to Boomtown Casino Bossier City, hereafter known as Boomtown, arising out of markers issued according to the guidelines set forth by Boomtown. I waive any right, statutory or otherwise, to stop payment on any instruments issued in connection with markers issued to me. I agree to pay a fee of $15 for each marker returned unpaid by my bank. I agree to submit to the personal jurisdiction of the state and federal courts sitting in Bossier City, Parish of Bossier, State of Louisiana, should legal action be taken by Boomtown to collect any outstanding balances owed by me to Boomtown and agree to pay all costs of collections including attorney's fees. I hereby waive any defense to any such action based on lack of personal jurisdiction or improper venue.

I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize Boomtown and its affiliates, directly or through its vendors, to conduct such investigations related to the above information as deemed necessary for the approval of my application for a marker line. I am aware that this application is required to be prepared in accordance to 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 authorize Boomtown to conduct such investigations pertaining to the above information as it deems necessary in its sole discretion for the approval or rejection of my Customer Service Agreement. 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 a marker line at Boomtown. 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 further authorize Boomtown to debit any of the accounts listed above in repayment of any balance that is not paid on or before the due date following the time period as determined by Boomtown. I authorize Boomtown, in its sole discretion, to apply all chips, plaques, slot tokens or slot tickets I may redeem, first to the reduction of my outstanding credit balance with the remainder, if any, to be returned to me. I agree that any partial payment on account of outstanding debt owed to Boomtown shall be deemed an acknowledgement by me of the total remaining outstanding balance.

For the purposes of Louisiana law, under Louisiana Revised Statute Title 10 Section 3-104(f), a marker is identical to a check and may be deposited in or presented for payment to a bank or other financial institution on which the marker is drawn.

Privacy Policy

Click here to view the Privacy Policy for Boomtown Casino Hotel Bossier City.

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

Signature

I, the undersigned, hereby authorize Boomtown Casino Hotel Bossier City, its affiliates, and its vendors, including NRT Technologies, Inc. and VisuaLimits, LLC and its affiliates ("NRT") 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 Boomtown Casino Hotel Bossier City, its affiliates and its vendors, including NRT and its affiliates to verify such information through any source. Further, I authorize NRT and its affiliates to report any information to other casinos unrelated to Boomtown Casino Hotel Bossier City and its affiliates, excluding credit report data obtained from a credit agency, and to exchange any information collected with other parties unrelated to Boomtown Casino Hotel Bossier City. I hereby release and waive, and agree not to bring at any time in the future, any claims or demands against Boomtown Casino Hotel Bossier City, its affiliates and its vendors including NRT and its affiliates relating to any credit investigation made pursuant to my authorization 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.