Front Money Application The Mirage


*  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
$
$
$
$
$
$

Gaming Information Other Casino Credit

Gaming Information Other Casino Credit





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License Agreement

I am aware that this application is required to be prepared and that I may be subject to civil or criminal liability if any material information provided is willfully false. I am aware that the above additional information provided may be submitted to third parties for review and/or investigation for validation purposes. I have reviewed and attest to the accuracy of the information provided by me and contained in this application. I understand that further information may also be requested from me in future for review and/or investigation for validation purposes for maintaining my account. Mirage Hotel-Casino LLC does not disclose any information about our guests or former guests to anyone except as permitted by law.

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 aggregate report data in order to evaluate my front money 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, 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 front money 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 front money, 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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