Financial Account Holder Signature ,--, Date &nail Address' ' I do not Wish to receive CMS notification or special offers evadable to Cingular %Vbeiess customers. Case No. 08-80736-CV-MARRA P-006609 SDNY_GM_02767160 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA 00253968 EF