Mailing Information (Print Clearly)
Full Name: DOB: / / .
Last First Middle
Address: Phone:
City: State: Zip:
Spouse's Name: DOB: / / .
Employer/Firm Name: Position:
Address: Phone:
City: State: Zip:
Mail To Be Received At: Business: Residence:
E-mail: Fax:
Casino Account Information:
Casino Name Player Card Number Tier (Gold, Silver, 7 Star, etc.)
__________________________ _________________________ ______________________
__________________________ _________________________ ______________________
__________________________ _________________________ ______________________
__________________________ _________________________ ______________________
Banking Information:
Bank#1:
Address:
City: State: Zip:
ABA No.: Account No.:
Type Of Acct.: Business: Personal: Phone:
Bank Officer: Position:
Bank#2:
Address:
City: State: Zip:
ABA No.: Account No.:
Type Of Acct.: Business: Personal: Phone:
Bank Officer: Position:
Maximum Credit Requested: $
Front Money you usually bring: $
Personal Description:
Sex: HT: WT: Eyes: Hair:
SSN: - - Drivers License: State:
Signature: Date: / /
By my signature, I authorize any casino to check my credit ratings.
Sign and Fax to Casino Tours, Ltd. at 770-642-8831 or 478-474-1748.
Or mail to: Casino Tours, Ltd, P.O. Box 27477 Macon, GA 31221
04-Feb-2008