Apply For Casino Credit

Personal Information:

*First Name:

Middle Inital:

*Last Name:

*Date of Birth:

*Social Security Number:

*Credit Amount Requested:

*Expected Arrival Date:

*Where do you want to receive mail? HomeOffice

*Marketing info to: HomeOffice

Drivers Licesnse Information:

*Drivers License Number:

*State:Select: Out of Country Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

*Expiration Month:Select: 01 02 03 04 05 06 07 08 09 10 11 12

*Expiration Year:Select: 2012 2013 2014 2015 2016 2017 2018

Second Form of ID Information:

Other ID Number:

Type:

Expiration Month:Select: 01 02 03 04 05 06 07 08 09 10 11 12

Expiration Year:Select: 2012 2013 2014 2015 2016 2017 2018

Spouse Information (optional):

Spouse First Name:

Spouse Middle Initial:

Spouse Last Name:

Spouse Date of Birth:

Spouse Social Security Number:

Contact Information

*Address:

*City:

*State:Select: Out of Country Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code:

*Phone:

Alternate Phone:

Employer Information

*Employer:

*Type of Business:

*Address:

*City:

*State:Select: Out of Country Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code:

*Phone:

Fax:

*Position:

*Number of Years Employed:

Bank 1 Contact Information:

*Bank Name:

Bank Address:

*Bank City:

*Bank State:Select: Out of Country Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Bank Zip:

Bank Phone Number:

Savings Account Number:

*Checking Account Number:

Bank Contact Person:

Bank Contact Person Position:

*Bank Routing Number:

Bank 2 Contact Information:

Bank Name:

Bank Address:

Bank City:

Bank State:Select: Out of Country Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Bank Zip:

Bank Phone Number:

Savings Account Number:

Checking Account Number:

Bank Contact Person:

Bank Contact Person Position:

Bank Routing Number:

Electronic Signature:

PLEASE READ AND SIGN BELOW
I hereby certify that the information provided above and in connection with the submitted credit application is true and complete. I authorize LVH – Las Vegas Hotel & Casino and its representatives, managers, agents and assigns ("Company") to verify such information through any source, to obtain any credit related, gaming related or employment history information about me (“Information”), to report any information to another casino or a credit reporting agency and to exchange any Information with any of the affiliates or representatives of the Company and agree not to hold Company responsible for the information released and further not to hold Company liable for its use of the information or procurement thereof. No violation of the Credit Application/Agreement or any regulation by the Company shall constitute (a) a defense in any action by the Company or a person acting on behalf of the Company to enforce an instrument or the debt that the instrument represents or (b) a basis for a valid counterclaim to such an action or a claim in any action. Further, this Credit Application/Agreement is not an “other agreement” within the meaning of NRS 104.3117 that would modify, supplement or nullify any instrument.
Warning: For the purposes of Nevada law, a credit instrument is identical to a personal check and may be deposited to a bank or other financial institution in 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.

*Type in your first and last name to electronically sign this form:

*Today’s Date