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Page 12 <br />(Form Approved by City Attorney’s Office November 1, 2009) <br />SERVICE PROVIDER: Please fill in the spaces and sign in the box appropriate for <br />your business entity. <br />Corporation <br />Limited <br />Liability <br />Company <br />Partnership <br />______________________________________ <br />[Service Provider’s Complete Legal Name] <br />By: __________________________________ <br /> Signature <br />Typed/Printed Name of Signer: Nathaniel Feaster-Eytchison <br />Title of Signer: _OWNER__________________ <br />Date: 04/21/23_______ <br />Sole <br />Proprietorship ______________________________________ <br />[Typed/Printed Name] <br />______________________________________ <br />Signature <br />Date: ____________________ <br />PNW AXE THROWING LLC