L'auberge Baton Rouge - Credit Application

Credit Application L'auberge Baton Rouge

Applying for

* 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 *

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 *

Do you wear glasses? *

** 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 *

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 *

See PEP definition

Domestic PEP

A domestic PEP is a person who holds — or has held within the last 5 years — a specific office or position in or on behalf of the Canadian federal government, a Canadian provincial government, or a Canadian municipal government, for example:

Governor General, lieutenant governor or head of government;
member of the Senate or House of Commons or member of a legislature;
deputy minister or equivalent rank;
ambassador, or attaché or counsellor of an ambassador;
military officer with a rank of general or above;
pesident of a corporation that is wholly owned directly by Her Majesty in right of Canada or a province;
head of a government agency;
judge of an appellate court in a province, the Federal Court of Appeal or the Supreme Court of Canada;
leader or president of a political party represented in a legislature; or
ayor, reeve or other similar chief officer of a local government (municipal governments include cities, towns, villages and rural (county) or metropolitan municipalities).

Foreign PEP

A foreign PEP is a person who holds or has held one of the following offices or positions in or on behalf of a foreign state:

head of state or head of government;
member of the executive council of government or member of a legislature;
deputy minister or equivalent rank;
ambassador, or attaché or counsellor of an ambassador;
military officer with a rank of general or above;
president of a state-owned company or a state-owned bank;
head of a government agency;
judge of a supreme court, constitutional court or other court of last resort; or
leader or president of a political party represented in a legislature.

HIO

The head of an international organization is a person who is either:

the head of an international organization established by the governments of states; or
the head of an institution established by an international organization.
an international sports organization.

When we refer to the head of an international organization or the head of an institution established by an international organization, we are referring to the primary person who leads that organization, for example a Managing Director, Director-General, President, CEO etc.

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 Debt *

Mortgage/Loan Amount *

Credit Card Amount *

Other Amount *

Form of Funds *

Source of Funds *

* I understand that the casino may request documentation verifying the source of my funds. I agree to provide such documentation if requested and certify that all information provided in this application is true and accurate.

Account #1

Pre-paid debit and credit cards 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 this a Private Client Account? *

Is Account a Trust? *

Branch Address *

Bank Officer *

Officer Position *

Phone *

Account #2

Pre-paid debit and credit cards 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 this a Private Client Account?

Is Account a Trust? *

Branch Address

Bank Officer *

Officer Position *

Phone *

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

Privacy Statement - In the course of providing credit and other financial services at L'Auberge Casino and Hotel Baton Rouge, we obtain certain and personal information about our customers or former customers that may be considered confidential. We maintain physical, electronic and procedural protections to guard our customers' nonpublic personal information. We do not disclose any of this information about our customers or former customers to anyone, except as required by law. In the future, it may be necessary to modify or supplement the Privacy Statement. Our customers will be informed of any changes to our policy in notices that we will provide as required by law. Customer Agreement - I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize L'Auberge Casino and Hotel Baton Rouge or its parent company, Pinnacle Entertainment to conduct such investigations pertaining to the above information as it deems necessary for the approval and maintenance of my credit limit, including but not limited to obtaining a credit report from a national credit reporting agency. I am aware that this application is required to be prepared by the regulations of the Louisiana Gaming Control Board and the Riverboat Gaming Commission and I may be subject to civil or criminal liability if any material information provided by me is willfully false. I understand that the information provided by me to complete this application is provided for the purpose of inducing L'Auberge Casino and Hotel Baton Rouge to issue credit to me. I authorize L'Auberge Casino and Hotel Baton Rouge or its parent company, Pinnacle Entertainment to conduct such investigations pertaining to the above information as it deems necessary in its sole discretion for the approval or rejection of my credit limit. I also certify that I am 21 years of age or older. I understand that Louisiana law prohibits persons under the age of 21 from engaging in gaming activity. Accordingly, I must be 21 years of age or older to apply for and obtain credit at L'Auberge Casino and Hotel Baton Rouge. I am aware that false misrepresentation of my age on this application and/or my entry onto the casino floor if I am less than 21 years of age subjects me to criminal prosecution. I agree to pay all sums due as a result of credit extended, loaned, or advanced to me by L'Auberge Casino and Hotel Baton Rouge whether by way of chips, plaques, slot tokens or checks within the time period determined as according to the guidelines set by L'Auberge Casino and Hotel Baton Rouge. I further authorize L'Auberge Casino and Hotel Baton Rouge to debit any of the accounts listed above in repayment of any of the sums that are not paid on or before the due date following the time period as determined by L'Auberge Casino and Hotel Baton Rouge. I authorize L'Auberge Casino and Hotel Baton Rouge, in its sole discretion, to apply any and all chips, plaques and slots tokens I may redeem, first, to the reduction of my outstanding credit balance with the remainder, if any, to be returned to me. I agree that any partial payment on account of outstanding debt owing to L'Auberge Casino and Hotel Baton Rouge shall be deemed an acknowledgement by me of the total remaining balance of that outstanding debt. In the event an attorney is employed to collect the credit balance, I agree to pay the cost of such collection together with reasonable attorney fees. This agreement shall be governed by the laws of the State of Louisiana. For the purpose of any action for the enforcement or collection of any outstanding debt I owe or may owe in the future to L'Auberge Casino and Hotel Baton Rouge, I hereby submit to the personal jurisdiction of the state and federal courts sitting in Baton Rouge, Parish of East Baton Rouge, State of Louisiana and I hereby waive any and all objections or exceptions I may have to (1) such courts' lack of jurisdiction over my person and (2) improper venue.

Privacy Policy

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 L'auberge Baton Rouge 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 L'auberge Baton Rouge, 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