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When you sit at a slot machine you insert your Sail & Sign and withdraw $ from there (room charge) to play.
You can enter a few hundred if you want, play a few dollars, and cash out.
You then go to the cashier and give them your card and ask to cash out and they give you money.
I did this on my last carnival cruise in August when I was short on cash.
I roomed charged and cashed out.