Permission To Provide Information
To:
_______________________________________________________________________________________________________________________
_____________________________________________________________
_____________________________________________________________
RE:
________________________________________________________________________________________________________________________
You are authorized to give WALL STREET BROKERS, Inc.,
any and all information and documentation requested at any time.
A copy or facsimile of this signed document is to be considered an original.
NAME (typed or printed):__________________________________________
Signature:______________________________________________________
NAME (typed or printed):__________________________________________
Signature:______________________________________________________
NAME (typed or printed):__________________________________________
Signature:______________________________________________________
cc: Wall Street Brokers, Inc.
500 Wall Street Suite 405
Seattle WA 98121
Phone: 206.448.1160
Fax: 206.448.8476
e-mail: lorelei@eskimo.com
URL: www.wallstreetbrokers.com
WSBI file #_____________