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The undersigned holder of the card or checking account specified below does herby instruct Global Cash Access, L.L.C., a Delaware limited liability company (“GCA”), to reject any cash advance transaction requested using the card or checking account. Cardholder/Acct-holder is making this instruction pursuant to the Self Transaction Exclusion Program (STEP) initiative of GCA’s Responsible Gaming Program and understands that this instruction may only be revoked using the written form of revocation. This instruction shall become effective upon GCA entering the Card/Account information into its computer systems as a card/acct subject to a STEP instruction and shall remain in effect until GCA removes the Card/Account from its computer systems as a card/acct subject to a STEP instruction following GCA’s receipt of a written revocation of such instruction using the form attached hereto. Cardholder represents and warrants to GCA that Cardholder has all right, power and authority to make this instruction on behalf of all joint holders of the Card(s). The undersigned authorizes GCA to obtain credit reports using the information provided herein for the purpose of verifying the undersigned’s identity and authority to make this instruction. Cardholder agrees that GCA’s acceptance of this instruction would be solely as an accommodation to Cardholder, without any consideration to GCA; therefore, in no event shall GCA bear any liability for its acceptance, rejection, compliance or non-compliance with this instruction or any revocation thereof for any reason whatsoever. Cardholder hereby waives any claims against GCA in connection with this instruction or any revocation thereof, including without limitation GCA’s rejection of transactions pursuant to this instruction, GCA’s failure to comply with this instruction or GCA’s rejection of transactions prior to the effectiveness of any revocation of this instruction, and Cardholder agrees to indemnify GCA against any liability arising from or relating to this instruction or any revocation thereof, including, without limitation, any liability to any joint holders of the Card(s), VISA U.S.A., Inc., MasterCard International, Inc., Discover/Novus Inc, any debit network, the issuer of the Card(s), any acquiring or merchant bank involved in the processing of transactions involving the Card(s) or any gaming establishment. Check Accountholder represents and warrants to GCA that accountholder has all right, power and authority to make this instruction on behalf of all joint holders of the Checking account. The undersigned authorizes GCA to obtain credit reports using the information provided herein for the purpose of verifying the undersigned’s identity and authority to make this instruction. Accountholder agrees that GCA’s acceptance of this instruction would be solely as an accommodation to Accountholder, without any consideration to GCA; therefore, in no event shall GCA bear any liability for its acceptance, rejection, compliance or non-compliance with this instruction or any revocation thereof for any reason whatsoever. Accountholder hereby waives any claims against GCA in connection with this instruction or any revocation thereof, including without limitation GCA’s rejection of transactions pursuant to this instruction, GCA’s failure to comply with this instruction or GCA’s rejection of transactions prior to the effectiveness of any revocation of this instruction, and Accountholder agrees to indemnify GCA against any liability arising from or relating to this instruction or any revocation thereof, including, without limitation, any liability to any joint Accountholders, TeleCheck, any acquiring or merchant bank involved in the processing of transactions involving the Check Account or any gaming establishment. Cardholder/Checking
Accountholder agrees that this instruction and any revocation thereof shall
be governed in all respects by the laws of the State of Nevada, without
regard to any conflicts of laws provisions which may result in the
application of the laws of any jurisdiction other than the internal law
other the State of Nevada. Card/Account holder agrees that any claim or
controversy arising out of this instruction or any revocation thereof shall
be settled by final and binding arbitration under the Commercial Arbitration
Rules of the American Arbitration Association in Clark County in the State
of Nevada by three arbitrators, one of whom shall be selected by GCA, one of
whom shall be selected by Card/Account holder and the third of whom shall be
selected by the mutual agreement of the other two arbitrators. Judgment on
any award rendered by the arbitrators may be entered in any federal or state
court located in Clark County in the State of Nevada. The arbitrators shall
award to the prevailing party, if any, as determined by the arbitrators, all
costs, fees and expenses of such arbitration, including attorneys’ fees.
This information will remain confidential, and will be used solely for the purposes set forth above. Should you have questions about the status of your instruction, please call Cheryl Dotson at (800) 833-7110 ext. 3006. Mail completed form to Global Cash Access, L.L.C., Attn: Cheryl Dotson 3525 E Post Rd., Suite 120, Las Vegas, NV 89120, or fax to (702) 262-5039. Do you or someone you love have a problem with gambling? Contact Maryann (520) 405-2842 at info@gamblinghelpaz.com "THERE IS HOPE.....I CAN HELP....."
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