WIRE TRANSFER APPLICATION

Wire Transfer Application

Attention: Casino Credit Department
P.O. Box 760, Las Vegas, NV 89101 • Fax: 702-386-2219

Marketing Rep:
Expected Arrival Date:*
MM slash DD slash YYYY
Gaming Preference*
- Select All
- Slots
- Bingo
- Table Games
- Keno
Name*
First Last
Email Address:*
Residence Phone*
Alt. Phone Number:
Residence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alt. Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of Employer:*
Business Phone:*
Address of Employer:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Business:*
Position with Company:*
Drivers License Number:*
Social Security Number:*
Date of Birth:*
MM slash DD slash YYYY
Wire Transfer
Name on Account*
Amount:*
Name of Bank*
I give Playlv and its representative’s permission to obtain and verify information on this form with any source, obtain employment history, and exchange information with others about my credit with Playlv. “Warning: For the purposes of Nevada Law, a credit instrument is identical to 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 it may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt.”
Signature*
Signature Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Booking - V2

WIRE TRANSFER APPLICATION

Wire Transfer Application

Wire Transfer

Inquiries

Follow Us

SIGN UP FOR UPDATES: