Credit Application

Maximum Credit Requested (minimum amount is $1000)*

Personal Information

Name*

Email*

Phone*

Address*

Years at Residence*

Please enter a number less than or equal to 100.

Date of Birth*

Social Security*

Drivers License Number*

Issuing State*

Arrival Date*

Expiration Date*

Credit Decision*

How would you like to be notified on credit decision?:

Mail
Email
Phone

Work Information

Employers Name*

Address*

Phone*

Years Employed*

Type of Business*

Position*

Sole Proprietor?*

Yes
No

If Yes, personal name on check

Financial Information

Yearly Income*

Source*

Total Debt*

Source*

Banking Information

Bank Name*

Address*

Account Number*

ABA Bank Routing Number*

Type of Account*

Personal
Business

2nd Bank Name

Address

Account Number

ABA Bank Routing Number

Type of Account

Personal
Business

Consent*

Do you agree to these terms?

1. This application for credit (the “Agreement”) shall be governed and construed and interpreted in all respects in accordance with the laws of the State of California and the Cabazon Band of Mission Indians.
2. Each of the parties to this Agreement hereby expressly submit and consent to exclusive jurisdiction in California to hear and determine any claims or disputes pertaining directly or indirectly to this Agreement or to any matter arising therefrom.
3. I agree that the FSRC may, in its sole discretion, apply any and all chips or tickets which I rightfully possess to reduce any debt owed by me to the FSRC.
4. I understand that if I fail to pay my debts to the FSRC, upon demand, the FSRC may legal action against me.
5. I, the undersigned, agree that in the event this extension of credit needs to be placed with an attorney or agency, I will pay all costs of collection, including but not limited to, reasonable attorney fees, interest at the maximum rate allowed by law, court costs and any bank fees incurred through appeal.

I, the undersigned, represent that all statements made by me in this Agreement are true and correct. I acknowledge that I am responsible for repayment of any and all credit issued. I understand that if the FSRC provides me with chips or tickets in exchange for a check or marker, the chips or tickets are the equivalent of cash, and I understand that a marker signed by me may be negotiated by the FSRC 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 FSRC may have against me. I authorize the FSRC to conduct such investigation pertaining to the above information as it deems necessary for the approval of my credit limit. I authorize the FSRC or any of its affiliates to order a consumer report and gaming report from a credit reporting agency to exchange pertinent information with others who may properly receive this information. I understand and acknowledge that I may be subject to civil and criminal liability if I knowingly provide false, inaccurate or misleading information. To all banks, financial institutions and credit reporting agencies; I authorize the FSRC to conduct inquiries into my credit worthiness. You are hereby authorized to release any and all information pertaining to such inquiries, as requested by an appropriate representative of the FSRC. A photostatic copy of this Agreement and authorization will be considered as effective and valid as the original.

CREDIT APPLICATION