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Important Account Changes! After July 1, 2005, Alpine Overhead Doors, Inc. may be unable to communicate with you by fax (EVEN AT YOUR REQUEST), if the completed form below is not kept on file.

In order to ensure an uninterrupted flow of account information to you, your urgent attention to this matter is appreciated.

*** Please Fill Out, Print, Sign and Fax ***

Company Name:
Contact Name:
Fax Number:
Additional Fax Numbers Authorized:
Fax Number2:
Fax Number3:
Fax Number4:
Fax Number5:
Contact Name of person providing consent:
Title:

I understand that by providing the fax numbers above, on behalf of the Member Company Name listed above, that I am authorized to and do provide consent for this Company to receive faxes and emails sent by Alpine Overhead Doors and its affiliates for the purposes of transmitting important account updates and all required and relevant lease documentation.

Signature: X ________________________________________ Date:_______________________

***Please fax this completed form to (631) 642-0800, as soon as possible***

Thank You!