Southland Casino - Credit Application

Credit Application Southland 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? *

* 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 * (US applicants only)

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 *

Game Preference and Limit *

Request For Hold *

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 cards, credit cardsBusiness Accounts 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 cards, credit cardsBusiness Accounts 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

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

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

Warning: For the purposes of Arkansas 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 Arkansas which may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt.

I agree that each draw against my credit line is a separate advance of money by Southland Casino Racing. If I receive the advance before I execute a credit instrument,I promptly will sign a credit instrument in the amount of the advance. I hereby authorize Southland Casino Racing in its sole discretion to apply any and all chips, cash, or cash equivalent I may redeem first to the reduction of any outstanding credit balance, with the remainder, if any, to be returned to me.

I authorize Southland Casino Racing, its subsidiaries, affiliates and agents to complete any of the following missing items on these instruments: (1) the name of the payee, (2) any missing amounts, (3) a date, (4) the name, account number, and/or address and branch of any bank or financial institution, and (5) any electronic encoding of the above items. This information can be for any account from which I now have or may in the future have the right to withdraw funds, regardless of whether that account now exists, or whether I provided the information on the account to Southland Casino Racing.

I authorize Southland Casino Racing to investigate my credit report and to furnish information concerning such credit records to credit reporting agencies and others who may properly receive this information.

I agree to (a) to pay all costs of collection, including attorney’s fees, (b) to waive any requirements of presentment, (c) that the debt for which this credit instrument is issued was incurred in the State of Arkansas, (d) that Arkansas law exclusively applies to this credit instrument and the enforcement thereof, and (e) submit to the exclusive jurisdiction of any court, state or federal, in the State of Arkansas.

I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize Southland Casino Racing to conduct such investigations pertaining to the above information as it deems necessary for the approval of my credit limit. I certify that I am 21 years of age or older.

Privacy Policy

Click here to view the Privacy Policy for Southland Casino.

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 Southland 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 Southland 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

Sign Here

Signature

Date

Credit Application Southland Casino

Informational Questions

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 Southland Casino

Informational Questions

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!