| FILL-IN FORM INSTRUCTIONS: | |
| 1. | Fill in the form fields using your computer.The form will automatically provide mathmatical calculations. |
| 2. | Print 2 copies of the form. Sign and date if necessary. |
| 3. | Mail COPY 1 to the address on the form and keep COPY 2 for your records. |
PRINTABLE FORM INSTRUCTIONS: |
|
| 1. | Print 2 copies of the form. |
| 2. | Use a pen to fill out the form completely. |
| 3. | Mail COPY 1 to the address on the form and keep COPY 2 for your records. |