Four Queens and Binions Casinos - Credit Application

Credit Application Four Queens and Binions Casinos

Language

Informational Questions

Please answer the following questions before completing and submitting the application

When was the last time you visited a casino? *

How many times do you visit casinos per year? *

Do you play slots or tables? *

Are you past due on any of your accounts? *

Is your bank account negative? *

Do you understand this is not a loan or credit card, and that the balance is due in full at the end of your trip? *

Do you understand that by applying, we will pull a credit report? *

Have you visited our casino before? *

Do you have a player’s club card with our casino? *

Do you understand that this is an on-demand account that will be linked to your checking account for payment? *

Do you understand that the funds being requested must be available in the account referenced on the application? *

Do you understand that approval may take up to 72 hours? *

Do you understand that funds advanced are to be used only for gaming purposes during this trip? *

* Indicates field is required

Personal Information

First Name *

Middle Name

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 *

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 *

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.

Account #1

Pre-paid debit and credit cards 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 this a Private Client Account? *

Is Account a Trust? *

Branch Address *

Bank Officer *

Officer Position *

Phone *

Account #2

Pre-paid debit and credit cards 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 this a Private Client Account?

Is Account a Trust? *

Branch Address

Bank Officer *

Officer Position *

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

The Instant Bank Verification can be run on Personal Accounts from US and Canadian Banks only. Business Accounts are not available through the Instant Bank Verification service at this time.

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

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Limit

Casino

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Limit

Casino

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Casino

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Limit

Casino

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Casino

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Casino

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Limit

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

Sign Here

Signature

Date

License Agreement

TLC Casino Enterprises, Inc., Four Queens, LLC dba Four Queens Hotel and Casino (Four Queens), and Vintage Vegas Gaming, LLC dba Binions Gambling Hall and Hotel (Binions)

ENDORSE RESPONSIBLE GAMING: At your request, we will provide you with information on our self-limit program. If you or anyone you know may have a problem gaming responsibly, please call the 24-hour Problem Gamblers Help Line at 1-800-522-4700.

I give Four Queens and/or Binions authorization to obtain and verify at various times as it deems reasonable my financial information (including but not limited to bank account balance information) and employment history from any source.

I represent that at the time I sign any marker, I have on deposit in accounts on which I am an authorized signatory for all purposes, without restriction, funds sufficient to pay such marker upon demand or presentment.

I acknowledge that irrespective of any gambling, debt collection or currency exchange laws in the country in which I reside, I have the ability and intent to legally pay through my bank or financial institution the funds represented by the markers signed by me, and I hereby waive any such laws that may otherwise prohibit or limit my obligations as provided herein.

I agree that each marker I sign is a separate transaction. 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 agree that any credit granted to me may be suspended or revoked at any time and without notice by the Four Queens and/or Binions, and I hereby release the Four Queens and/or Binions, including its officers, employees and agents, from any and all claims, damages or losses that I may incur as a result of such credit being suspended or revoked.

To contact casino credit, call (702) 924-5263.

For the purposes of Nevada law, a credit instrument is identical to a personal check and may be deposited in or presented for payment to a bank or other financial institution on which the credit instrument is drawn. Willfully drawing or passing a 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 in the State of Nevada which may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt.

Privacy Policy

Click here to view the Privacy Policy for Four Queens and Binions Casinos.

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 Four Queens and Binions Casinos 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 Four Queens and Binions Casinos, 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 Four Queens and Binions Casinos

Informational Questions

Personal Information

Trip Information

Employment Information

Financial Information

Domestic PEP

Foreign PEP

HIO

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

Privacy Policy

Signature

Physical Signature

Credit Application Four Queens and Binions Casinos

Informational Questions

Personal Information

Trip Information

Employment Information

Financial Information

Domestic PEP

Foreign PEP

HIO

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

Privacy Policy

Signature

Physical Signature

Instant Bank Account Verification –
Speeds up approval!