Credit Application Southland Casino

Informational Questions

Please answer the following questions before completing and submitting the application

*  Indicates field is required
Personal Information

Personal Information





* **
* **
* **


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 cards, credit cardsBusiness Accounts are not valid options.
 * Applicant must be the sole proprietor of this account
Secondary Bank Information

Account #2

Pre-paid debit cards, credit cardsBusiness Accounts are not valid options.
 * Applicant must be the sole proprietor of this account

Instant Bank Account VerificationSpeeds up approval!

Click here for more security details


Gaming Information Other Casino Credit

Gaming Information Other Casino Credit





Sign Here

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

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