nature Authorizer's Signature bitiatOeS Name & at Stamp roil:Woes Autborizet. Name & Ext Stamp Client/Ca/ler Name: in. k.f..- Client Telephone: (PHU S /rj '4 Call Back Name: 600e)) 031, Call Back Signature- Call Back Date/Time 12- 09 Z_Y40pAnn EFTA01587444 Obtained E Obtained E. Applicable •