Exhibit 99.5

FORM OF BENEFICIAL OWNER ELECTION FORM

 

I (we) acknowledge receipt of your letter and the enclosed materials relating to the offering of rights (the “Rights”) to purchase shares of common stock, par value $0.0001 per share, of Full House Resorts, Inc. (the “Company”).

In Part I of this form, I (we) instruct you whether to exercise the Rights distributed pursuant to the terms and subject to the conditions set forth in the prospectus dated [______ __, 2016] (the “Prospectus”).

   

PART I  

BOX 1.		o		Please do not exercise the Rights.
BOX 2.		o		Please exercise the Rights as set forth below:

		Number of Common Stock				Subscription Price				Payment
Line 1. Basic Subscription Right:		________________		x		$1.30		=		$______________
Line 2. Oversubscription Right:		________________		x		$1.30		=		$______________

By exercising the oversubscription right with respect to my (our) Rights, I (we) hereby represent and certify that I (we) have fully exercised my (our) basic subscription right received in respect of shares of common stock held in the below described capacity.

Total Payment Required = $______________ 

BOX 3.		o		Payment in the following amount is enclosed: $___________________
BOX 4.		o		Please deduct payment from the following account maintained by you as follows:

(Sum of Lines 1 and 2 must equal total of amounts in Boxes 3 and 4)

Type of Account: ______________________________		Account No. _________________________________
Amount to be deducted: $________________________

___________________________________________

Signature

___________________________________________

Name (please print)