Credit Application

Personal Information

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Abbreviation if USA (ex. CA)

Trip Information

$ 20K = 20000

Employment Information


(Please note if retired by entering 'retired')
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Financial Information (Account #1)

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Financial Information (Account #2)

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Other Casino Credit


* Field is required
** One of these fields is required


*Income from alimony, child support or separate maintenance payments need not be revealed if you do not wish to have it considered as a basis for repayment of the requested credit.

I have completed this application for casino credit and agree that this credit line will be used solely for gaming purposes at Hollywood Casino at Charles Town Races ("Hollywood Casino"). I certify that I have reviewed all of the information provided above and that it is true and accurate. I will advise Hollywood Casino if any of this information changes. I understand that this application is required to be completed by regulations of the West Virginia Lottery Commission and that I may be subject to civil and criminal liability if any information provided by me is willfully false.

I authorize Hollywood Casino to conduct such investigations to verify the information provided and to obtain such credit information relating to me that it considers necessary to approve and thereafter maintain this credit line. I understand and agree that Hollywood Casino may disclose credit information concerning my credit record to credit reporting agencies and others.

I understand that I am responsible for the repayment of credit extended to me. The instruments issued as a result of this credit line and intended solely to provide an additional remedy to Hollywood Casino, and the obligations evidenced by such instruments are governed by the laws of the state of West Virginia. I waive any right, statutory or otherwise, to stop payment on any instrument issued in connection to any credit extended to me. Hollywood Casino may, in its discretion, litigate any dispute arising out of this credit line before any Court having jurisdiction over me. I consent to the jurisdiction of any court, federal or state, in West Virginia. I waive any defense bases on lack of personal jurisdiction or improper venue. Should legal action be taken to collect an outstanding balance, I agree to pay all costs of collection, including reasonable attorneys' fees.

I hereby expressly authorize Hollywood Casino to apply any and all gaming chips I may redeem, first to the payment/reduction of any outstanding credit balance, with the excess, if any, to be returned to me.

Hollywood Casino at Charles Town Races appreciates the trust that our customers place in us and we recognize the importance of protecting the confidentiality of our customers' non-public personal information that we have in our possession. The information is used to ensure accuracy in reporting and record keeping and to carry out requested transactions. Keeping this information secure is a top priority for Hollywood Casino. The purpose of this notice is to inform you about the procedures we follow for collecting, using and disclosing this information.

The following Privacy Policy applies to customers, former customers, and applicants for credit. We will provide our Privacy Policy to customers when they open a new account and annually thereafter. If we change the Privacy Policy, you will be notified in advance.

  1. We obtain non-public personal information about clients from the following sources:
    • Information received as part of the account opening process (such as name, address and social security number) or as a result of other requested services.
    • Information about customer transactions. This information allows us to generate reports on behalf of the customer.
    • Information we may receive from credit reporting agencies that has been supplied by other sources (such as creditworthiness and credit history)
  2. The non-public personal information that is obtained is safeguarded in accordance with our internal policies and procedures. The policies permit only those employees who need to know the information in order to perform their duties to have access to a customer's non public personal information. We maintain physical, electronic and procedural safeguards designed to comply with federal standards to guard a customer's non-public personal information.
  3. We may disclose the non-public personal information we collect about our customers to our affiliates, and to certain non-affiliated third parties such as credit reporting agencies and check cashing services, with whom we have contracted to perform services on our behalf. We may disclose all or parts of the information that we obtain as described above. We may also disclose non-public personal information about our clients as permitted or required by law.
  4. We will update our policy and procedures when necessary to ensure that your privacy is maintained and that we conduct our business in a way that fulfills our commitment to you. If we make any material changes in our Privacy Policy, we will make that information available to customers through our website and/or other communications.


Click here to view the Privacy Policy for National Cred-A-Chek, Inc.

I acknowledge that I have read and accept the above privacy policy.
I, the undersigned, hereby authorize and instruct Hollywood Casino at Charles Town and its agent National Cred-A-Chek, Inc. ("NCC") 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 Hollywood Casino at Charles Town, NCC or its affiliates to verify such information through any source and to report any information to another casino or a credit reporting 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 NCC 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.

National Cred-A-Chek, Inc. ("NCC") 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 National Cred-A-Chek, Inc. 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.