Order form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=95 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>2</B><B>00</B><B>6 Collection Price     $275.00 a savings of $75.00</B></div> <div> <A HREF="mailto:gibby@prtcnet.org" TARGET="_top" TITLE="mailto:gibby@prtcnet.org"><U><B>Email Donna</B></U></A></div> <div> <FONT SIZE="4" COLOR="#CC0033" FACE="Times New Roman" ><B>Now accepting </B></FONT><A HREF="https://www.paypal.com/" TARGET="_blank" TITLE="https://www.paypal.com/"><U><B><IMG SRC="0bf25170.gif" border=0 width="37" height="23" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A><B>                                                                                                 </B></div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="http://www.daylilydonna.com" TARGET="_top" TITLE="http://www.daylilydonna.com"><U><B>http://www.daylilydonna.com</B></U></A><B> </B></div> <div> </div> </td> </tr><tr> <td valign="top" height=385 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Donna Gibson</B></div> <div> <B>2712 Hwy. 577 E.</B></div> <div> <B>Annville, Ky. 40402                   </B></div> <div> <B>PHONE: 606-364-3027</B></div> <div> <B> E-mail: gibby@prtcnet.org</B></div> <bR> <bR> <div>                                    <B><U>NAME                                                                        </U></B></div> <div>                 </div> <div> <B>           </B><B><U>ADDRESS                                                                                        </U></B></div> <bR> <div> <B>             </B><B><U>CITY                                        STATE             ZIP                         </U></B></div> <bR> <div> <B>             </B><B><U>PHONE                                         </U></B></div> <bR> <div> <B>            </B><B><U>E-MAIL ADDRESS                                                                         </U></B></div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B>         </B></FONT><B><U> Sh</U></B><B><U>i</U></B><B><U>p</U></B><B><U>ping date                             </U></B></div> <bR> <div> <B>Substitutions allowed:   Yes_____ No_____   (Please list possible substitutions)</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="662" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div> <B> </B></div> </tD> <tD VALIGN=BOTTOM><NOBR><div> <B>Quantity</B></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="353"><div> <B>Cultivars</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div> <B>Price</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div> <B>Totals</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div> <B> </B></div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Total from this side of order form</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Total from reverse side of order form</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="353" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Net Total for plants</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Sales Tax (for Kentucky residents only) 6%</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="484" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3><NOBR><div> <B>Shipping to USA Priority Mail at $9.00 plus .50 per plant over 4</B></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 39 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Shipping to Canada Priority Mail at $13.00 plus $1.00 per fan over 2 </B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Plus Phyto-Sanitary Certificate $50.00</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="353" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Gift Certificates</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="484"><div> <B>Total Amount Enclosed</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="353" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 56 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><bR> <bR> <bR> </tD> <tD VALIGN=BOTTOM WIDTH="353"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="56" ALIGN="bottom" WIDTH="353" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="56" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="56" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="56" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 20 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><div> <B>BONUS OR SUBS.</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 19 WIDTH="10"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="353"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="59" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="13"><div>  </div> </tD> <tD VALIGN=BOTTOM WIDTH="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="62" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B> </B></div> </td> </tr></table></body>