Hard Rock Casino Rockford - Credit Application

Credit Application Hard Rock Casino Rockford

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 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 Account a Trust? *

Branch Address *

Bank Officer *

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 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 authorize this casino to investigate my credit record and to furnish information concerning such credit record to credit reporting agencies. I certify that I have reviewed all of the information provided on this application and that it is true and accurate. I authorize this casino to conduct any investigations pertaining to this application as it deems necessary for the approval of my credit limit and to use such information as it deems necessary in connection with my request. I am aware this application is required to be prepared by the regulations of the Illinois Gaming Board and I may be subject to civil and criminal liability if any material information provided by me is knowingly false. I authorize this casino, as needed, to share this information with other gaming jurisdictions.

In the event of non-payment, I understand that in addition to the amount of the check or draft, I may be liable for a return fee as permitted by state law for all costs and expenses, including reasonable attorney's fees, incurred by the casino in collection of the outstanding amount, whichever is greater, plus statutorily permitted interest thereon.

Privacy Policy

Click here to view the Privacy Policy for Hard Rock Casino Rockford.

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 Casino Rockford 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 Hard Rock Casino Rockford, 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 Hard Rock Casino Rockford

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

Privacy Policy

Signature

Physical Signature

Credit Application Hard Rock Casino Rockford

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

Privacy Policy

Signature

Physical Signature

Instant Bank Account Verification –
Speeds up approval!