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Service Agreement

We've made our application process simple and easy.  Just complete the form below to submit your application.  Once your application is approved, visit the Main Cage with a valid photo ID to finalize your service agreement.

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Personal Information
Employment Information
  • Mail to: (Please check one) *
  • Amount must be $2,500 or greater
Banking Information

Personal checking accounts only, or sole proprietor business accounts.

  • First Bank
  • Second Bank
  • I give my permission to Coushatta Casino Resort to obtain information regarding my account(s) with the financial institutions listed or subsequently discovered. I will not hold these financial institutions responsible for any information released. In the event a legal action is brought to collect any amount owed, I agree: 1.) To submit to the jurisdiction of any court—tribal, federal or state, in Louisiana, 2.) To pay reasonable cost and attorney fees incurred. In the event a “marker” or draft or other instrument payable to the order of Coushatta Casino Resort is not honored by my bank (for “insufficient funds, “account closed, “payment stopped” or similar reasons), I understand that criminal charges for “Issuing Worthless Checks” may be applicable.

  • I hereby acknowledge and agree that this application may be signed electronically and that such electronic signatures shall be deemed an original for all purposes. By signing this application electronically I have the authority to do so and such shall be sufficient to bind the respective party under this application.

  • Required fields marked (*)

If you have any questions, please call Dianne Richard at 1-800-584-7263 ext. 7281 or Cage Supervisor at ext. 7238. Fax to: 337-738-7384. Mail to: P.O. Box 1503 Kinder, LA 70648

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