f State, check the box and proceed to Item 17. Complete Addresses for the Following (Do not abbreviate the name of the city. Items 4 and 5 cannot be P.O. Boxes.) 4 T RE OF PR FICE CITY STATE ZIP CODE CITY STATE ZIP CODE 6. WJLING ADDRESS OF CORPORATION. IF DIFFERENT THAN ITEM 4 CITY STATE ZIP

he Global Phoneworks Terms and Conditions found at www.aJobalphoneworks.corniterms. Signature Date Attention Company Street (No deliveries to P.O. Boxes) City State Zip Phone FEES Weekly Rental $25.00 2-way shipping $40.00 A $300 deposit will be charged the day the phone is shipped and will

umber Work Phone Number Cell Phone Number Home Phone Number Work Phone Number Cell Phone Number Mailng Address (if different from home address. P.O. Boxes may be used) Social Security or Tax ID Number Date of Birth Sods Security or Tax ID Number Date of Birth Are you a U.S. Citizen? Nan-U.S. Citiz

le for delivery to street addresses in the 48 contiguous United States. Select parcel items can ship to Alaska & Hawaii. We cannot ship to APO/FPO, P.O. Boxes. or U.S. Territories. Prices are in U.S. dollars and are subject to change without notice. 2013 Homer TLC, Inc. All rights reserved. Privacy & Secur

77 Ltd 2. Entity Type (e.g. Corporation, Partnership, LLC, Trust, Government Agency, etc.) Public Limited company 3. Physical Street Address (P.O. Boxes are not acceptable) BERKELEY SQ HOUSE, BERKELEY SQ, LONDON WI) 6BD 4. Phone Number S. Fax Number N/A 6. Contact Person (full name) MARTY B

ay to a Citibank branch you select, or directly to your address on record in the continental U.S. for an additional nominal charge - no delivery to P.O. Boxes or to locations outside of the continental U.S. Foreign currency is available in more than 50 different currencies. Daily order limits and cut-off t