Fields marked with an asterisk * are required.
* Limit Requested $ 
* First Name     Middle Initial    * Last Name 
  Preferred First Name   * Residence Phone ( -
    Cell Phone ( -     Fax ( -
* Residence Address    * City 
* State/Province    * Postal Code 
* Country 
* Name of Employer  
* Business Phone ( -  ext 
* Address of Employer    * City 
* State/Province    * Postal Code 
* Country 
* Type of Business       * Position with Employer  
* Social Security Number: - -      Email Address  
* Date of Birth  (mm/dd/yyyy)   / /     * Expected Arrival Date  (mm/dd/yyyy)   / /
* Mail Marker Information To:
Marketing Representative  
Alternate Address       City  
 State/Province:      Postal Code 
 * Primary Bank (1) Name and Branch      ABA#
 * Street Address        *  City  
 * State/Province:      *  Postal Code 
 * Country     Bank Phone Number:  
 *  Primary Account Number:        Secondary Account Number:    
Name on Business Account:      Bank Contact and Position:  
Bank (2) Name and Branch     ABA#
Street Address       City  
State/Province:     Postal Code 
Personal Account Number:      Business Account Number:  
Name on Business Account:      Bank Contact and Position:  
Marker Accounts at Other Casinos (list):  

          Mandalay Bay ENDORSES RESPONSIBLE GAMING: At your request, we will provide you with information on our self-limit program. We will also cancel or limit your access to marker signing privileges at your written request. If you or anyone you know may have a problem gaming responsibly, please call the 24-hour Problem Gamblers HelpLine at 1-800-522-4700 . I give MGM Resorts International and its affiliates authorization to obtain and verify my financial information (including but not limited to account balance information) from any source, obtain my financial and employment history, and exchange information with others about my financial and account experience with MGM Resorts International and its affiliates. I agree not to hold any of the entities responsible or liable for the information released, nor MGM Resorts International and its affiliates for its use of any such information. I agree that MGM Resorts International and its affiliates may retain and use the information on this application and any information it receives based on my authorization whether or not I am granted marker signing privileges.
          As a condition to being granted marker signing privileges, I agree to sign credit instruments, AKA markers or checks (hereinafter “markers”) in the amount of the funds (e.g. chips, cash, tokens, etc.) issued to me. Further, I authorize MGM Resorts International and its affiliates to complete any of the following information on those markers: (1) name of payee, (2) a date, (3) name, account number and/or address of any of my banks and financial institutions, (4) electronic encoding of the above, and (5) as otherwise authorized by the law. The information inserted may be for any account from which I now or may in the future have the right to withdraw funds, regardless of whether that account now exists, and whether I provided the information on the account to MGM Resorts International and its affiliates. I REPRESENT THAT AT THE TIME I SIGN ANY MARKER, I HAVE ON DEPOSIT IN ACCOUNTS ON WHICH I AM AN AUTHORIZED SIGNATORY FOR ALL PURPOSES, WITHOUT RESTRICTION, FUNDS SUFFICIENT TO PAY SUCH MARKER UPON DEMAND OR PRESENTMENT.
          I acknowledge that irrespective of any currency exchange laws in the country in which I reside, I have the ability and intent to legally pay through my bank or financial institution the funds represented by the markers signed by me and given to MGM Resorts International and its affiliates. I also acknowledge that an independent agent collecting front money deposits or payments on my outstanding balance is my agent and not an agent for MGM Resorts International or any of its affiliates.
          I agree that each marker I sign is a separate transaction. If I receive the funds before I execute a marker, I promptly will sign a marker when presented to me in the amount of the funds I received.
          I agree (a) to pay all costs of collection, including attorney's fees, (b) to waive any requiremetns of presentment (c) that the debt for which this credit instrument is issued was incurred in the State of Nevada (d) that Nevada law exlusively applies to this credit instrument and the enforcement thereof and (e) submit to the exclusive jurisdiction of any court, state or federal, in the State of Nevada.
           I agree that the information set forth above is true and accurate to the best of my knowledge.

          “Warning: for the purposes of Nevada law, a credit instrument is identical to a 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 may result in criminal prosecution in addition to civil proceedings to collect the outstanding debt.”

Please verify that you have read and agree to the above disclosures by typing the word YES in the field below.