Bristol Casino - Credit Application

Front Money Application Bristol Casino

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? *

Do you understand that a front money account means that you would deposit your own funds to gamble with at the casino? *

* 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 # *

Deposit Amount *

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 *

Gaming Information Other Casino Front Money

Do you have Front Money 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 am aware that this application is required to be prepared and that I may be subject to civil or criminal liability if any material information provided is willfully false. I am aware that the above additional information provided may be submitted to third parties for review and/or investigation for validation purposes. I have reviewed and attest to the accuracy of the information provided by me and contained in this application. I understand that further information may also be requested from me in future for review and/or investigation for validation purposes for maintaining my account. HR Bristol, LLC does not disclose any information about our guests or former guests to anyone except as permitted by law.

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

* I acknowledge that I have read and accept the above privacy policies

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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Signature

Date