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15 <br />SERVICE PROVIDER: Please fall in the spaces and sign in the boy: appropriate for <br />your business <br />entity. <br />Corporation1 <br />[Service Provider's Mrnplete Legal Name] <br />By:i�/1 <br />Typed/Printed�Name: 06 r <br />Its: <br />Date: Q <br />Partnership <br />(general) <br />[Service Provider's Complete Legal Name] <br />a Washington general partnership <br />By: <br />Typed/Printed Name: <br />General Partner <br />Date: <br />Partnership <br />(Limited) <br />[Service Provider's Complete Legal Name] <br />a Washington limited partnership <br />BY <br />Typed/Printed Name: <br />General Partner <br />Date: <br />Sole <br />Proprietorship <br />Typed/Printed Name: <br />Sole Proprietor: <br />Date: <br />Limited <br />Liability <br />[Service Provider's Complete Legal Name] <br />Coinparay <br />z Washington limited Lability company <br />By: <br />I yped/Printed Name: <br />Managing Member <br />Date: <br />7,, )10, <br />121 <br />