TO THE • Cards Or Ga $ " 12,000.0D Twelve Thousand and 00/100 - Q1194021 /953d Allot) Dallas II°0OO6 S Ott Cards OH 43218.2584 Accourtt / 5466 1602 4877 8597 0000ES 11, 8 I *I' CO O oo :71- cal oo W o O o >- ° I z O O rn >- O z O "a≥ -id O u_ O H H n. a a r z z LIJ

Cfl- Name of Receiving Firm: Cheek Ql Issue a check in the amount of $ Reopieni's Name Recrpeni's Maaing Address - Account Name. payable to: Accourtt Number: at Receiving Firm EFTA01403582 Oty/Symbot/Seciinty. Qiy/SYmboi/Secunly- Standing Authorization C3 The undersigned hereby requests that