CASINO ONLINE CREDIT APPLICATION  


TODAY IS
BASIC INFORMATION
* LIMIT REQUESTED: (Numeric only)
$
PLAYER'S CLUB NUMBER:
* LAST NAME
* FIRST NAME
M.I.
* SSN (9 digits, no dashes)
* DATE OF BIRTH (mm/dd/yyyy)
 
PASSPORT ID
COUNTRY OF ORIGIN
 
* DRIVERS LICENSE ID
DRIVERS LICENSE STATE
 
     
* ADDRESS OF RESIDENCE (No P.O.Boxes accepted)


* CITY
* STATE
* ZIP CODE (xxxxx)
* # OF YEARS AT CURRENT RESIDENCE
(Enter years by rounding to closest number of years)
* EMAIL ADDRESS
* RESIDENCE PHONE
* ARRIVAL DATE (mm/dd/yyyy)
EMPLOYMENT INFORMATION
* EMPLOYMENT       RETIREMENT
* EMPLOYMENT-FIRM NAME
* POSITION
* TYPE OF BUSINESS

* SOLE PROPRIETORSHIP
YES       NO

* ADDRESS OF BUSINESS
   
* CITY
* STATE
* ZIP CODE (xxxxx)
* # OF YEARS AT CURRENT BUSINESS
(Enter years by rounding to closest number of years)

* BUSINESS PHONE
 
* APPROXIMATE AMOUNT OF ALL PERSONAL OBLIGATIONS INCLUDING MORTGAGES:(Numeric only)
$
BANK INFORMATION

(Only PERSONAL checking accounts or SOLE PROPRIETOR business checking accounts will be accepted)

BANK # 1
* BANK NAME

* BRANCH
* ADDRESS OF BANK
* CITY
* STATE
* ZIP CODE (xxxxx)
* BANK PHONE (enter phone number without dashes)
* TYPE OF ACCOUNT
PERSONAL       SOLE PROP.
* ABA # (9 digits)
* BANK ACCOUNT #

BANK # 2
BANK NAME

BRANCH
ADDRESS OF BANK
CITY
*STATE
ZIPCODE (xxxxx)
BANK PHONE (enter phone number without dashes)
TYPE OF ACCOUNT
PERSONAL       SOLE PROP.
ABA # (9 digits)
BANK ACCOUNT#


I am applying for credit, check-cashing and/or marker privileges from Pechanga Resort & Casino ("PRC"). I hereby certify that the information provided in my application is true and accurate and that I have not omitted or concealed material information. I understand that the PRC is authorized by the National Indian Gaming Authority to operate as a gaming facility. I am providing information in this credit application as an inducement to the PRC to grant me credit, to accept my check or marker, and/or to obtain cash or cash equivalents. I understand that if I omit material information or provide false or inaccurate information on my application, I may be subject to civil and/or criminal penalties. I understand that the PRC has the right to revoke any credit extended to me, and to take action to collect any debt owed by me to the PRC.

I understand the Pechanga Resort & Casino is established on the reservation lands of the Pechanga Band of the Luiseño Indians, a sovereign Indian nation, and that the PRC has the same sovereign powers as the Pechanga Tribe. I understand that the Pechanga Tribe has enacted ordinances which govern civil liability on the reservation lands and that the Pechanga Tribe has established a Pechanga Gaming Disputes Court which has jurisdiction over actions for the collection of debts from persons and entities to whom the PRC has extended credit. I agree to abide by the laws and ordinances of the Pechanga Tribe and the PRC.

I authorize the PRC to : (a) investigate and to verify the information that I have provided; (b) review and analyze my credit record; (c) furnish information concerning my credit application to credit reporting agencies and others who may properly receive this information; and (d) take other steps consistent with the investigation and verification of my financial resources and financial responsibility.

I agree that the PRC may in its sole discretion apply any and all chips or tokens which I rightfully possess to reduce any debt owed by me to the PRC. I understand that if I fail to pay my debts to the PRC upon demand, the PRC may bring an action against me in Pechanga Tribe Gaming Disputes Court.

I understand that if the PRC provides me with chips or tokens in exchange for a check or marker, the chips or tokens are the equivalent of cash, and I understand that a marker signed by me may be negotiated by the PRC in the same manner as a check. I understand that if my check or marker is dishonored by a financial institution because of insufficient funds in the account, because the account was closed, because of a stop payment order or for any other reason, I may be exposed to criminal penalties in addition to any civil remedies that the PRC may have against me.

I authorize the PRC to collect the costs and reasonable attorney fees incurred in connection with efforts to collect any debt owed by me to the PRC. I agree that the Pechanga Tribal Gaming Disputes Court may exercise personal jurisdiction over me, and that service of process and any summons, complaint, or other notice issued in connection with the collection of a debt owed by me may be delivered by registered or certified mail, or by any private delivery service such as Federal Express, to the address listed on my application (unless I provide the PRC with written notice of a change of my address). I understand that a judgment of the Pechanga Tribal Gaming Disputes Court entered against me will be valid and enforceable the same as if it were entered in any state or federal court which could exercise personal jurisdiction over me.
* Please verify that you have read and agree to the above disclosures by typing the word 'yes' in the field below.

* Required Fields