Credit Application The Mirage


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Personal Information

Personal Information





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** You must provide a Passport or Driver's License
** International Applicants must provide a Passport or International ID
Trip Information

Trip Information

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Employment Information

Employment Information

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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
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Primary Bank Information

Account #1

Pre-paid debit and credit cards are not valid options.
 * Applicant must be the sole proprietor of this account
Secondary Bank Information

Account #2

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

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Gaming Information Other Casino Credit

Gaming Information Other Casino Credit





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License Agreement

The Mirage Casino-Hotel, LLC ("Mirage") ENDORSES RESPONSIBLE GAMING: At your request, we will provide you with information on our self-limit program. We will also cancel or limit your access to marker signing privileges at your written request. We reserve the right to administratively self-limit you. If you or anyone you know may have a problem gaming responsibly, please call the 24-hour Problem Gamblers HelpLine at 1-800-522-4700.

I give Mirage authorization to obtain and verify at various times as it deems reasonable my financial information (including but not limited to account balance information) and employment history from any sources. I further consent to and acknowledge that the information on this application (as well as subsequent information obtained by Mirage) and my financial and account experiences and transitions with Mirage, may be shared among Mirage and with their business partners, which may share such information with other third parties.

I acknowledge that all such information will be subject to Mirage’s Privacy policy located at http://www.hardrockhotelcasinolasvegas.com/casino/credit or will be made available on request. I agree not to hold any of the individuals or Mirage entities and any other parties with whom such information is shared, responsible or liable for the information released, received or used (or the action taken by Mirage) as a result of the receipt or use of such information. I agree that Mirage may retain and use the information on this application and any information it receives based on my authorization whether or not I am granted marker limit privileges. I further agree that upon request of Mirage I will provide updated personal and financial information.

I understand that certain Mirage subsidiaries are considered to be financial institutions under the United States' Bank Secrecy Act and are subject to State of Nevada gaming and other laws. As such, I agree that information on this Marker Limit Application and other information Mirage may obtain about me, (including but not limited to my permanent address and SSN or passport information) may be used by Mirage to comply with Mirage’s obligations under both federal and state law.

As a condition to being granted marker limit privileges, I agree to sign credit instruments, AKA markers or checks (hereinafter "markers") in the amount of the funds (e.g. chips, cash, tokens, etc.) issued to me. Further, I authorize Mirage to complete any of the following information on those markers: (1) name of payee, (2) a date, (3) name, account number and/or address of any of my banks and financial institutions, (4) electronic encoding of the above, and (5) as otherwise authorized by law. The information inserted may be for any account from which I now or may in the future have the right to withdraw funds, regardless of whether that account now exists, and whether I provided the information on the account to the Mirage and its affiliates. I agree that the marker does not become a negotiable instrument until such time as Mirage inserts information necessary to transform the marker into a negotiable instrument, which time I agree may be subsequent to the date that I signed the marker. I REPRESENT THAT AT THE TIME I SIGN ANY MARKER, I HAVE ON DEPOSIT IN ACCOUNTS ON WHICH I AM AN AUTHORIZED SIGNATORY FOR ALL PURPOSES, WITHOUT RESTRICTION, FUNDS SUFFICIENT TO PAY SUCH MARKER UPON DEMAND OR PRESENTMENT.

I acknowledge that irrespective of any currency exchange laws in the country in which I reside, I have the ability and intent to legally pay through my bank or financial institution the funds represented by the markers signed by me and given to Mirage. I also acknowledge that an independent agent collecting front money deposits or payments on my outstanding balance is my agent and not an agent for Mirage.

I agree that each marker I sign is a separate transaction. If I receive the funds before I execute a marker, I promptly will sign a marker when presented to me in the amount of the funds I received.

I agree (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 Nevada (d) that Nevada 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 Nevada.

I agree that the information set forth above and information i may provide in the future to Mirage is, and will be, true and accurate to the best of my knowledge.

"Warning: for the purposes of Nevada 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 Nevada which may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt."

Privacy Policy

Click here to view the Privacy Policy for The Mirage.

Click here to view the Privacy Policy for NRT Technologies, Inc. and VisuaLimits, LLC

Signature

I, the undersigned, hereby authorize and instruct The Mirage 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 The Mirage, 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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