Additions & Ammendments Form

ADDITION & AMENDMENT FORM

To: DMS Marketing Inc. Fax: (780) 486-1421

or mail to: 101, 10620—178 St NW., Edmonton, AB T5S 2E3

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Add_______ Change _______ Delete_______

Add_______ Change _______ Delete_______

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Add_______ Change _______ Delete_______

Add_______ Change _______ Delete_______

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Name __________________________________ Address __________________________________ City/Prov. __________________________________ Postal Code_______________Phone_____________

Add_______ Change _______ Delete_______

Add_______ Change _______ Delete_______

From : Your Name: ____________________________________________________ Your Company: ____________________________________________________ Address: ____________________________________________________ City/Prov.: __________________________ Phone:____________________

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