Fields marked with an asterisk * are required.

* Limit Requested $
* Title
* First Name
Middle Initial
* Last Name
Preferred First Name
* Gender
* ID Type
* ID#
* Issuer
* Expiration Date
* Residence Phone
Cell Phone
*Residence Address
* City
* State/Province
* Postal Code
* Country
* Name of Employer
* Business Phone
* Address of Employer
* City
* State/Province
* Postal Code
* Country
* Type of Business
* Position with Employer
* Years at Company
* Years in Industry
* Business Website
* Annual Income
* Total Value Of Assets
* Amount Of Indebtedness
* 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
Postal Code

Financial Institution

Payment from your personal account is required unless prior arrangements have been authorized by MGM Resorts International or any of it's gaming subsidiaries.

Primary Financial Institution

* Primary Bank Name and Branch
* 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

Secondary Financial Institution

Bank Name and Branch
Street Address
Postal Code
Personal Account Number
Business Account Number
Name on Business Account
Bank Contact and Position
Marker Accounts at Other Casinos (list)
you, or any member of your immediate family, presently hold or have you, or any member of your immediate family, previously held a political office?
If yes, what position, in what state/country and over what period of time?
Position held
Time in the Position:

          MGM Resorts International and each of its subsidiaries and affiliates, including BLUE TARP REDEVELOPMENT, LLC dba MGM SPRINGFIELD ("MGM SPRINGFIELD") 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. We reserve the right to administratively self-limit you. If you or anyone you know may have a problem gaming responsibly, please call the 24-hour Problem Gamblers HelpLine at 1-800-426-1234.

          I give MGM SPRINGFIELD authorization to obtain and verify at various times as it deems reasonable my financial information (including but not limited to account balance information) and employment history from any and all sources. I further consent to and acknowledge that the information on this application (as well as subsequent information obtained by MGM SPRINGFIELD) and my financial and account experiences and transitions with MGM SPRINGFIELD, may be shared among MGM SPRINGFIELD and with their business partners, which may share such information with other third parties. I acknowledge that all such information will be subject to MGM SPRINGFIELD's Privicy policy located at or will be made available to me on request. I agree not to hold any of the individuals or MGM SPRINGFIELD entities and any other parties with whom such information is shared, responsible or liable for the information released, received or used (or the action taken by MGM SPRINGFIELD) as a result of the receipt or use of such information. I agree that MGM SPRINGFIELD 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 limit privileges. I further agree that upon request of MGM SPRINGFIELD I will provide updated personal and financial information that will be documented in our credit tracking system.

          I understand that certain MGM SPRINGFIELD subsidiaries are considered to be financial institutions under the United States' Bank Secrecy Act and are subject to state gaming and other laws, including the laws of the Commonwealth of Massachusetts. As such, I agree that information on this Marker Limit Application and other information MGM SPRINGFIELD may obtain about me, (including but not limited to my permanent address and SSN or passport information) may be used by MGM SPRINGFIELD to comply with MGM SPRINGFIELD's obligations under both federal and state law.

          As a condition to being granted marker limit 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 SPRINGFIELD 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 SPRINGFIELD.I agree that the marker does not become a negotiable instrument until such time as MGM SPRINGFIELD inserts information necessary to transform the marker into a negotiable instrument, which time I agree may be subsequent to the date that I signed the marker. 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 SPRINGFIELD. 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 SPRINGFIELD.

          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 reasonable attorney's fees, (b) to waive any requirements of presentment (c) that the debt for which this credit instrument is issued was incurred in the Commonwealth of Massachusetts (d) that Massachusetts law exlusively applies to this credit instrument and the enforcement thereof and (e) submit to the jurisdiction of any court, state or federal, in the Commonwealth of Massachusetts and irrevocably waive any defenses that I may have as to lack of personal jurisdiction, improper venue, or inconvenient forum.

          I agree that the information set forth above and information i may provide in the future to MGM SPRINGFIELD is, and will be, true and accurate to the best of my knowledge.

I certify that I have reviewed all of the information provided above and that it is true and accurate. I authorize MGM Springfield to conduct such investigations pertaining to the above information in accordance with applicable federal and state laws and regulations as it deems necessary for the approval of my credit limit. Such investigation may include verification of the information I have provided with a consumer credit bureau, a casino credit bureau, my bank, and/or a bank verification service. I am aware that this application is required to be prepared in accordance with Massachusetts Gaming Commission regulations and I may be subject to civil or criminal liability if any material information provided by me is willfully false.


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