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#


By signing below, I give Pechanga Resort Casino and its officers, employees, agents and representatives authorization to obtain and verify my financial information periodically from any source and to exchange such information with others about my financial account experience with Pechanga Resort Casino. I agree not to hold any person or entity responsible or liable for its use of any such information. I provide on or in conjunction with any credit application or front money deposit and any information it receives based on my authorization, including but not limited to any information with regards to source of funds, whether or not I am granted credit. I further authorize Pechanga Resort Casino to obtain any records from my banks and financial institutions.

I agree that any credit granted to me may be suspended or revoked at any time and without notice by Pechanga Resort Casino and I hereby release Pechanga Resort Casino including its officers, employees, representatives and agents, from any and all claims, damages or losses that I may incur as a result of such credit being suspended or revoked.

Pechanga Resort Casino endorses responsible gambling. At your request, we will provide you with information on our self-exclusion program which will enable you to cancel or limit your access to credit or check cashing privileges. If you or anyone you know may have a problem gaming, please call 1 (800) GAMBLER (426-2537).
* Please verify that you have read and agree to the above disclosures by typing the word 'yes' in the field below.

* Required Fields