CasaBlanca Virgin River
Please Print Date:
Name Date of Birth Social Security #
Name (Spouse) Date of Birth Social Security #
( )
Residence/Mail Address Residence Phone
( )
City, State
Zip
Cell Phone
Firm
( )
Business Address Business Phone
City, State
Zip
Mail To: (Check one) Home Business Email: None
Marker Play Check Cashing Only
14 Day Requested Limit: $ $ Arrival Date:
(Individual) (Spouse)
Mesquite Gaming, LLC payment policies: Initial
(1) A statement will be sent 14 days after issuance date of the marker(s.)
(2)
(3) Any outstanding marker(s) will be automatically deposited into your bank acccount after 45 days from issuance of the marker.
(4) Any returns from the bank will result in a Return Fee of $35.00 per item attached to oustanding balance.
Signature
Date
Signature Co-Applicant
Date
I acknowledge that I have read and understand the above statement.
Customer agrees that the credit limit is only to be used for gaming purposes and must be paid back in accordance with the
A second statement will be sent 30 days after the issuance of the marker(s) stating that any outstanding marker(s) will be deposited
directly into your bank account within 15 days.
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 A CRIMINAL PROSECUTION IN ADDITION TO CIVIL
PROCEEDINGS TO COLLECT THE OUTSTANDING DEBT.
I certify that the information contained in this request for check/credit privileges is true and correct and that the credit requested is not primarily
for personal, family or household purposes. I acknowledge that Mesquite Gaming, LLC DBA CasaBlanca Resort Casino and Virgin River
Hotel & Casino ("CasaBlanca" "Virgin River") intends to rely upon the truthfulness of such information. By my signature below, I authorize
Mesquite Gaming, LLC and/or its employees to obtain consumer reports (including credit reports), contact financial institutions and obtain
financial information therefrom in order to evaluate my application. I expressly hold harmless Mesquite Gaming, LLC and its employees, all
consumer reporting agencies and all financial institutions for supplying or obtaining information concerning my financial and credit information
used to evaluate my request for a check/credit line.
ID# St Exp ID# St Exp
Male Male
Female Hair Eyes Height Weight Female Hair Eyes Height Weight
Bank (1) ABA# Per Acct#
Bus Acct#
Address Branch
City, St Zip
Phone Bank Rep
Bank (2) ABA# Per Acct#
Bus Acct#
Address Branch
City, St Zip
Phone Bank Rep
Bank (3) ABA# Per Acct#
Bus Acct#
Address Branch
City, St Zip
Phone Bank Rep
Bank (4) ABA# Per Acct#
Bus Acct#
Address Branch
City, St Zip
Phone Bank Rep
950 W. Mesquite Blvd * Mesquite, NV 89027 * (702) 346-6800 Ext 6759 * (702) 346-6707 Fax * www.itsmesquite.com
Identification
Bank Information
List below the bank account number(s) from which you will draw all checks and/or markers issued to the CasaBlanca Resort
Casino and/or the Virgin River Hotel & Casino (checking accounts only). All markers will be deposited in the following accounts
after 45 days.
