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4? `, •. <br />er <br />Name Maximum Transfer Amount* Telephone Number t' $ <br />1. AZ— ---17'—"R vc61e (/ Si)9(57Z 2. '100 a E, VI <br />2. ?ALA M. 5012-06. `-' (6s) 9rz - <br />3. <br />4. <br />Wire Transfer Authorization <br />*F7RSTAR <br />Customer Information <br />Affiliate Code: „9.a-� <br />Name: L / T4/ 0 ir <br />Address: t.;>0o�,v <br />City: L/No /../4io-?.s State: , ZIP: Account Number: 7 Via-' <br />Account Number: _3 ooO o . -.�-- <br />Amended Date: <br />Account Number: <br />JVire Initiation Authorized Representatives <br />Please indicate who needs authorization and check the applicable function. <br />❑ ❑ 0 <br />❑ ❑ 0 <br />*Default is $0.00. <br />Please provide your fax number if you require notification for incoming wire transfer activity. <br />Fax# -2-/ <br />Do you require daily mail confirmation on all wire transfer activity? yesX no 0 <br />Nonrepetitive Wire: <br />Semirepetitive Wire: <br />Fully Repetitive Wire: <br />All information is required to initiate a wire transfer. You would need to provide the <br />originator's name, address and account number; beneficiary bank, beneficiary name, <br />address, and account number; dollar amount and the value date of the wire transfer. <br />You would need to provide the dollar amount, the value date, and the message to be <br />included with the wire. All other data is retained by the Wire Transfer system,. <br />You would need to provide the dollar amount and the value date. All other data is retained <br />by the Wire Transfer system. <br />Changes/Notices <br />The individual(s) listed below are authorized to issue wire transfer instructions pertaining to our <br />account(s) at Firstar Bank in accordance with the Transfer s unds Terms and Conditions. <br />AZ -4A <br />Printed Name <br />-7Ac-f1_4€- 43 • <br />Printed Name <br />SC/It_oC, -- <br />Printed Name <br />Si <br />Signature <br />Signature <br />Authorization Information* <br />ame: cry orLi,io c t .S Phone:(6 ) 9I?-- <br />Customer/Compan <br />Authorized Si <br />Print Name: <br />30-1255 8/14/99 <br />er: <br />tLuiC M , <br />(Signature) <br />1�1_ \•C(' <br />Date: 6-- (-00 <br />