Slots of Vegas Credit Card Agreement Form
Dear Valued Slots of Vegas Casino Member,
Slots of Vegas Casino appreciates your business! You must completely fill out this form.
Slots of Vegas Casino requires a legible signature on this form.
This form must be accompanied with a photocopy of the front side of your Driver’s license or passport and a photocopy of the front and back of your credit card (s) that you have used to deposit. Your credit card(s) will only be used for the purpose intended, and will be charged for the specified amount you authorize. This form will act as a permanent signature on file for any previous or future credit card transactions.
Credit Card(s) #___________________________ Exp. Date _____/_____
Credit Card(s) #___________________________ Exp. Date _____/_____
Credit Card(s) #___________________________ Exp. Date _____/_____
Credit Card(s) #___________________________ Exp. Date _____/_____
Credit Card(s) #___________________________ Exp. Date _____/_____
Date of Birth: ______/______/______ Player PID (Username) ________________
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Name: ________________________ ________ _________________________
(First) (Int.) (Last)
Address: __________________________________________________
City: _________________ State______________ Zip _______________
Phone # (____) _______ - _______ Fax: (____) ________- __________
Email Address: ______________________________________________
I ________________________________________, knowing that my account information is private and it is my responsibility to maintain the privacy of my account, hereby authorize Slots of Vegas Casino to charge my credit card(s) for all deposits made into my account. I further agree that this payment is irrevocable.
Cardholder’s Signature: _____________________________________
Date: ______/______/_______
Please complete and return all information using any one of the following methods:
a. Scan and e-mail to ccprocessing@prismcasino.com
b. Toll Free Fax: 1-866-369-0548