OTC PR WIRE Ticker Authorization Form

I authorize OTC PR WIRE, LLC and OTC PR WIRE Press Partners that may include GlobeNewsWire, NewsFile and or Accesswire to issue a company wire press release on our behalf and using our public ticker symbol. I have authority to legally bind the company and to provide this authorization*. This form may be digitally signed via Adobe Sign or signed by hand & emailed to cs@otcprwire.com * Authorization form MUST be signed by a C-level of below public company and MUST include a valid company email, title and contact details from the company domain prior to OTC PR WIRE providing Wire Press Releases. NO Yahoo, Hotmail, Gmail or personal email will be accepted; nor will ADMIN@ IR@, INFO@ or PR@ via company email.

Company Name
Company Address
Ticker Symbol
Full Name Title
Email Phone Number
Signature Date

I further authorize the individuals listed below to request and approve content on behalf of the above public company:

Full Name Email Phone Number

* Permission hereby continually authorizes OTC PR WIRE, LLC & Wire Press Partners to utilize company’s ticker symbol and disseminate press releases once approved by company until permission granted from this form as of its efective date is removed via written correspondence via email cs@otcprwire.com


Credit Card Authorization Form

CARDHOLDER INFORMATION

Name
Billing Street Addres
City State Postal Code
Country
Email
Addres
Direct Phone

I hereby affirm that I am the owner of the below referenced credit card and that my name is listed on the front of the credit card.

hereby authorize OTC PR WIRE, LLC to charge my credit card (listed below) for services ordered by an authorized representative of

CREDIT CARD INFORMATION

Credit Card Type: MasterCard Visa American Express Discover Card
Number
Expiration Month Expiration Year Security Code
Cardholder Signature X Date / /

Form KYC (Know Your Customer)

1. Category Individual/Proprietary firm
Company
Trusts/Foundations
Partnership firm
2. Name of the Individual including alias/Proprietary Firm/Company/Trusts/Foundations/Partnership firm (name of all partners)
3. Permanent or Registered address of the Individual/Proprietary Firm/Partnership firm and partners/Company/Trusts/Foundations
Telephone Number
Fax Number
4. Principal Business address/es from which business is transacted of the Individual/Proprietary firm/Company/Trusts/Foundations/Partnership firm
Telephone Number
Fax Number
E-mail Address
Website
5. Name of Authorized signatory. Please provide recent ID Copy (Passport, Driver License), Email address ( NO Yahoo, Hotmail, Gmail or personal email will be accepted; nor will ADMIN@ IR@, INFO@ or PR@ via company email), Telephone, Cell phone number

I/We hereby declare that the particulars given herein above are true, correct and complete to the best of my/our knowledge and belief, the documents submitted in support of this Form KYC are genuine and obtained legally from the respective issuing authority. In case of any change in any of the aforementioned particulars, I/we undertake to notify you immediately in writing failing which the above particulars may be relied. I/we hereby authorize you to submit the above particulars to the customs and other regulatory authorities on my/our behalf as may be required.

Place Signature
Date Name




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