thplace: Phone: Address: SSN: Her current annual income: Her current job: Position/Employer's name DOCUMENTS from your CO-SPONSOR: Last 3 years Federal Tax Returns, W2's and copy of her US passport, US Birth Certificate or green card; and 11. The attached intake sheet must be completed and emailed back to us.

City State Account li Contact Person Phone it Fax ti ADDITIONAL INFORMATION (check if included) K Year-End Financial Statements (2 years) or Federal Tax Returns (2 years) K Resale Certificate K Distribution Agreement Agreement and Disclosures: EFTA00521645 I. As an inducement for Furniture Brands Inte

Contact Person Fax it (tea la,,) 11... . ,- ADDITIONAL INFORMATI I N (check if included) M 0 • Year-End Financial Statements (2 years) or Federal Tax Returns (2 years) Resale Certificate Distribution Agreement Agreement and Disclosures: EFTA00522662 I. As an inducement for Furniture Brands Internatio