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French Lick Springs Resort & Casino - about us

Phone: 812-936-9300
Fax: 812-936-2100
8670 West State Road 56
French Lick, Indiana 47432

1-888 MY HIDEAWAY
(1-888-694-4332)

To apply for a personal line of credit at French Lick Resort Casino, please complete the application form below. This application contains “required fields” that must be filled out completely with your personal information before it will allow you to “Submit”. Once your form has been submitted, a Credit Representative will contact you regarding your application. If you need assistance completing the form, please call 1-888-694-4332 extension 5849 or 5802.

The required minimum amount for a credit line is $1500.00.

Customer Account # :

CCID # :

Referred By :

License # :

Date :

Time :

First Name :*

Last Name :*

Middle Name :

Alias :

Mail to be Sent :*

Alternate Business Residence No Mail

Mother's Maiden Name* :

Address :*

City :*

State :*

Zip :*

Phone # :*

Email Address :*

# Years :*

Arrival Date:*

Credit Limit Request :*

Minimum $1,500

Social Security # :*

Date of Birth :*

Drivers License #*

State :*

Expiration Date :*

Passport # :

Country :

Other ID :

Federal

State

Military

ID #

Badge # :

Employer Name of Firm :*

Sole Proprietorship :*

Yes No

Type of Business :*

Position :*

Employment Street Address :*

Business Phone # :*

City :*

State :*

Zip :*

# Years:*

Alternate Street Address

Alternate Phone #

City :

State :

Zip :

# Years :

Bank #1 :*

ABA #:*

Street Address :*

City :*

State :*

Zip :*

Personal Account # :*

Bank #2 :

ABA #:

Address :

City :

State :

Zip :

Personal Account # :

Bank #3

ABA # :

Address :

City :

State :

Zip :

Personal Account #

I certify that I have reviewed all of the information provided and that it is true and accurate. I authorize French Lick Resort • Casino to conduct such investigations pertaining to the above information as it deems necessary for the regulation of the Indiana Gaming Commission and I may be subject to civil or criminal liability if any material information provided by me is willfully false. I hereby authorize French Lick Resort • Casino within its sole discretion, to apply any and all chips I may redeem first to reduction of any outstanding credit balance, with the remainder, if any, to be returned to me. I hereby authorize French Lick Resort • Casino to investigate my credit record and to furnish information concerning such credit record to credit reporting agencies and other who may properly receive this information

Applicant grants permission to French Lick Resort Casino to utilize information in this application to obtain independent credit reports. French Lick Resort Casino will not sell, disclose, or provide any of the information to any other entity except for the purpose of investigating the credit-worthiness of the applicant.

I have read and agree with the statement above.

* = Required

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