Credit Application Bristol Casino


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Personal Information

Personal Information





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* **
* **


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

Account #1

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

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





Sign Here

License Agreement

I hereby authorize HR Bristol, LLC, d/b/a Bristol Casino (hereinafter "HRB") to obtain a consumer credit report and to conduct such other investigations as it deems necessary, and to furnish information concerning my credit record to other credit-reporting agencies and others who may properly receive this information.

I certify that I am twenty-one (21) years of age or older. I understand that persons under the age of twenty-one (21) are not permitted to gamble. Accordingly, I must be twenty-one (21) years of age or older to apply for credit with HRB. I am aware that false misrepresentation of my age on this application subjects me to criminal prosecution.

I certify that I have reviewed all of the information provided on the application and verify that it is true and accurate. I authorize HRB to conduct such investigations pertaining to the above information as it deems necessary for the approval of my counter check limit.

I hereby authorize HRB, in its sole discretion, to apply any and all chips that I may redeem first to the reduction of my outstanding counter check balance, with the remainder, if any, to be returned to me.

I acknowledge that the HRB is not a "debt collector" as defined in 15 U.S.C. 1692(6) and that the Fair Debt Collections Practice Act does not apply to any actions taken by HRB to collect on any counter checks provided to me. I hereby unconditionally and irrevocably waive any rights I might have under the Fair Debt Collections Practice Act.

I agree that jurisdiction for any litigation arising in connection with the repayment of any counter check privileges extended to me by HRB of the collection of any bad check given by me to HRB properly lies in Virginia. I hereby specifically waive any right I may otherwise have to litigate any such matter in another state under the doctrine of "forum non conveniens". However, I acknowledge that each agreement contained in this paragraph is made for the benefit of HRB and may be waived by it at any time. I hereby consent to the domestication, in any country or jurisdiction in which I have ever resided or in which I have ever owned property, or in which I may reside or own property, of any judgment against me. I hereby irrevocablly and unconditionally waive any and all defenses to such domestication, procedural and substantive, that I might otherwise have. I agree that such judgment may be enforced against me or my property in any such country or jurisdiction in the same manner, and to the same extent, as a judgment that is rendered by a court in such country or jurisdiction.

I certify that all of the information provided on the application is true and accurate. I am aware that I may be subject to civil or criminal liability if any material information provided by me is willfully false.

Privacy Policy

Click here to view the Privacy Policy for Hard Rock Hotel & Casino Bristol.

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

Signature

I, the undersigned, hereby authorize and instruct Bristol 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 Bristol 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


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