"*" indicates required fields To request access to the Company's data site, I hereby certify I am as follows: A current Holder or Beneficial Owner of the Affinity Gaming 6.875% Senior Secured First Lien Notes due 2027 (the "Notes"). A prospective investor with a bona fide interest in the Notes and either i) a "qualified institutional buyer" as defined by Rule 144A under the U.S. Securities Act of 1933, as amended, or ii) not a " U.S. Person" as defined by Regulation S under the Securities Act of 1933, as amended. A FlNRA-registered security analyst. A market maker affiliated with any of the Initial Purchasers of the Notes. Amount By clicking on the box below and providing the required information I further certify and agree as follows:* The undersigned is neither a competitor, nor is acting on behalf of a competitor, of Affinity Gaming or any of its subsidiaries. Further the undersigned understands that it is providing the information contained herein solely for purposes of enabling Affinity Gaming to determine whether the undersigned should receive access to its password protected online data site on which it provides information in accordance with the indenture relating to the Notes. This is neither an offer to purchase or exchange any securities, including the Notes, nor creates any obligations whatsoever on the part of Affinity Gaming or the undersigned to sell or purchase any securities. Today's Date: Month Day Year Name of company/entity* Name of authorized signatory* Title of authorized signatory* Email:* Phone Number:*CaptchaNameThis field is for validation purposes and should be left unchanged.