Casino Marketing Executives - Credit Application

To apply for credit, please fill out this credit application form. Please do not leave any fields blank. If your form is accepted, a representative will contact you promptly for your signature and confirmation before submitting your application to the creditor.

Your Basic Info:

First Name:	Last Name:
Date of Birth:	Social Security #:
Email Address:
Credit Amount Requested:	Expected Arrival Date:

Spouse's Basic Info: (Fill in for a joint account. Otherwise, leave blank.)

Spouse's First Name:	Spouse's Last Name:
Spouse's Date of Birth:	Spouse's Social Security #:

Contact Information:

Residental Address:
City:	State:	Zip:
Primary Phone (with area code):	Other Phone (with area code):	Other Contact/Phone (with area code):

Where you want to recieve your mail:
Home Business

Mail marketing information to:
Home Business

ID Information:

Your Drivers License #:	State:	Expiration Date:
Other ID #:	Other ID Type:	Other ID Expiration Date:

Employer Information:

Employer:	Type of Business:	Position:
Employer Address:
City:	State:	Zip:
Phone (with area code):	Fax:	# of Years Employed:

Bank Information:

Bank Name:
Address:
City:	State:	Zip:
Telephone (with area code):	Contact Person/Position:	Bank Routing #:
Bank Account #:	Bank Account #:	Bank Account #:

Bank Name:
Address:
City:	State:	Zip:
Telephone (with area code):	Contact Person/Position:	Bank Routing #:
Bank Account #:	Bank Account #:	Bank Account #:

Upon receipt of this completed application, we will followup with you promptly to acquire your signature and the appropriate document(s) and submit the application to the creditor.