|
Attachment F:
<br />alth
<br />Anlimal Withdral al Form
<br />form jn;1,tr-u.cti<z,n;1,:
<br />1. -DOH mJCt;"IIC)' Pn:,p iJfecl C-' illlcl csp..afjn !EP f b;ar,-;a l;u:l,: t ;:, recc:1,-,, r,qlljC.Jt$f; r -r ti~•T"I
<br />.-..,d i<:ati,,,u fr~m k>cal h-ulth j1uu,d ictill,ns.
<br />2. To ,:m! ... r antn.•irals.. a NI'! wutin; LHJ simi,lt n<!<!U w =n,p·lete tiiis fa,rm. Ona, o:>mp,letl! xcan th., form
<br />a-,d c ll'QJJ ltt~ jllc1.1i::am;,ttt@:d oh.wa.;'_,, .,,.,! -tttsyco • ~c:,he«:19~d ,h.m,;s:,v M ; A'n t i,•fr.al
<br />vrith,dr.....,r in tnl! J.IJlb,j,,<rt 1m ...
<br />3 . DOH e,se nq• P,ep'ate-dno, ;md •~~u:~EP f1e,nl!=.:Fm-.e •~11<!:stl ..,,iti, lh Via.: in;r~ ~
<br />Vb~")' An,xi~i:,n t:, rm Jtr;>F-1)' ct,a· :ctl:.-ity. 'Qi·n ,,:,,n 11:~ ,eq cn h.,,. k -n • ,.,...,_ t>,.•
<br />OOH h:.;i::!c.rilt· , DOH E!>lt tt:il'J o,111 ,;,rt t:> l:ca~ 1 ~ ,e-. esh:~ di::at i:, ~ 1n eilJ.e rtheawteDt
<br />~ ~ l •c h;,i n ri,&:.c:t f ,~rn eDl!IH=::ln,.
<br />4,, im:d ' tk:u ar,,:;r,.,_1 :iJ:Ji:, DOH Ulhtaffw1T1 <:.g;nt;,;:t tb<: re q u ln;-1;:;oil h~lth j ll!l'~.n b
<br />conf<Tnn shipi,in; lacati<l,n and pot <>f <Dl>l!tact.
<br />S. DOH cJ'it ·w,11 :,i,s,_ ;, ~w10cmnarn•d order otl a,b :r t<:>lf!e ~,; uur,; bal e;ilrti j ucris'll~, a n.chle
<br />~ uunl:er n p-11:, ... ~,.arnd ~ /cinall ;c,ltt ., ,rpp=·=<I til'.I' -:>tan !,•irah to c re-c • ; --::al
<br />~e:1.ltl, Ju r1td'lctbi,, &fm-u:l:be fime ofarm.:ol '"F.,lld.1 up,r,n the, ll.rt-=nr:,·• ,f 'th~ ~il u.;:it-~•-~111'l o ,.,..,,,-,.,,1,
<br />a~--~~ral'fii:: l:;,ati::,n ,
<br />5 1'h c; c.ffit,i; lx;,I ealth lurln!i::ti; • ..-.ill tj;n nd :il1tJ!
<br />,1.,JM,..,..
<br />1. e q•ue,rms b::;il hea Ju~llltti::,, fli U ~" b .rtetlt<m I~ ylJWI.· ta CtOl'll fPII ..,lilllu,r, !iJil<lllalll'..-~ft b
<br />a ~ ai,lr:tbn :late~F ~tll!:nt 1 ""'•o::.:ois ollllu.sjlf~lh~ nfol'Ql lb,1:tnn1 F,i,nr,j ~ Sf .
<br />5, DOfl EJl iTh t1!t.r· hce o"'i:-lm :I kllh.i r.i l Xitlldr.rw;.I form f~• 7 :m.
<br />Requ ma Jol!!lil bc.slll>"jwmfiman;
<br />Orp<ti1olltiori, th1t th,c le><itll l>nlth ~,-~:iti~lhe ,rmlmtj~r:
<br />c-txt: Title :
<br />1'1tonil tf: E'-Mail:
<br />ll~~uestd,4n t'f,•iT'al.s-p ~l ud e ,ypc. Stl! ~•c qu.,,ntlty}: :5h1pJ"1ne, Ad<irl!S;S.:
<br />(flt! r.,. /fl~. 1S"'-9~ SOpod,t;,:ft/Jp ' /
<br />P;a;~ 1
<br />57
|