APPLICATION FOR

EAA MAILBOX RENTAL

COMPLETE APPLICATION AND RETURN IN PERSON TO EAA L1107 WLR.  (LIMITED BOXES AVAILABLE)

Price: (check appropriate box)

________    $60.00 semi-annual

________    $100.00 annual

________    $5.00 Deposit for Key.  (will be returned at time of termination)

By my signature, I hereby request one standard size mailbox at the EAA Service Center.  I understand that by obtaining a mailbox this is a one year period and that it will automatically be renewed for successive one-year periods unless I notify the EAA Service Center in writing.   The EAA reserves the right to cancel.

Signature

Date:_______________________________   EAA#______________________________

Name:__________________________________________________________________

Home Address:________________________________________________________________

City/State/Zip____________________________________________________________

Work Number:___________________ Home Number____________________________

Office only

Rental Date Effective: ___________________________________________

Suite Number:__________________________________________________