ccount ( GI 4'Ga.'X 0 Merchant Card Services R. e-FP-stElm* (Internet) 0 Creek Card Fiat Not 0 Pero II0 Cash Management U Night Depository El Other PP:Lel-trine CONFIDENTIAL FustBankPR000123 SD NY_GM_OOO 12960 CONFIDENTIAL EFTA_00123603 EFTA01268807 Firstaank Virgin Islands - Signature Ca

rapist O Other, please specify : Q.3 How often do the specialist/s consult within your centre? 0 Every 6 weeks 0 Every 8 weeks 0 Every 12 weeks El Other, please specify : Q.4 In which Regions or Medical Centres do you currently refer your patients to, in order to receive consultations and treatments

rapist K Other, please specify : Q.3 How often do the specialist/s consult within your centre? K Every 6 weeks 0 Every 8 weeks 0 Every 12 weeks El Other, please specify : Q.4 In which Regions or Medical Centres do you currently refer your patients to, in order to receive consultations and treatments

ist . 0 Other, please specify : Q.3 How often do the specialist/s consult within your centre? 0 Every 6 weeks I] Every 8 weeks 0 Every 12 weeks El Other, please specify : Q.4 In which Regions or Medical Centres do you currently refer your patients to, in order to receive consultations and treatments

rposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. El Other (see instructions). S Address (number, street. and apt. or suite no.) See instructions. 4 Exemptions (codes apply crly to certain entities. not in

rposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. El Other (see instructions). S Address (number, street. and apt. or suite no.) See instructions. 4 Exemptions (codes apply crly to certain entities. not in

rposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. El Other (see instructions). S Address (number, street. and apt. or suite no.) See instructions. 4 Exemptions (codes apply crly to certain entities. not in

rposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. El Other (see instructions). S Address (number, street. and apt. or suite no.) See instructions. 4 Exemptions (codes apply crly to certain entities. not in