Electronic Dissemination Authorization

STATE GAMING CONTROL BOARD TECHNOLOGY DIVISION 555 E. Washington Ave. #2600, Las Vegas, NV 89101 Phone: (702) 486-2043 Fax: (702) 486-2241 ELECTRONIC DISSEMINATION AUTHORIZATION Company Name: Company Representative: License #: Title: I request and authorize the Nevada State Gaming Control Board Technology Division to disseminate correspondence to the above listed company electronically at the below listed email address: Name: Email Address: Phone Number(s): This request and authorization applies to: Gaming device and associated equipment approvals/disapproval/rejections General Correspondence Other: Terms: All correspondence will be communicated via email as an unsecured attachment. Attachments will be formatted as an Adobe PDF file and will not be modifiable. Attachments may include proprietary and/or confidential information. Title: Yes No I authorize the dissemination of the above listed correspondence under the terms listed above. (Company Name) hereby agree to indemnify, hold harmless and defend, not excluding the State's right to participate, the State of Nevada, the Nevada Gaming Commission, the State Gaming Control Board, the Nevada Attorney General and each of their members, agents, and employees in their individual and representative capacities from any and all claims against the agencies or persons named in this paragraph, arising out of electronic dissemination of correspondence, and against all liabilities, expenses, damages, charges and costs, including court costs and attorney's fees, which may be sustained by the person or agencies named in this paragraph as a result of said claims, suits and actions. Representative Signature: Date Signed: THIS AUTHORIZATION DOES NOT EXPIRE. American LegalNet, Inc. www.FormsWorkflow.com