EFTA00089338

# Attorneys

- Jacqueline M. Hudkins
  Reema T. Maroun
- Morgan D. Jones
- Laura M. Tomasello
- Richard G. Anderson

- Martha L. Prizio
  John P. Rob
  Dennis P. Vachon*
  Candice M. O’Neil*
  Greg Racki*

- Admitted to Practice in NH & MA
- Admitted to Practice in VT & MA
- Admitted to Practice in MA & RI
- Admitted to Practice in NH & VT
- Admitted to Practice in NH
- Admitted to Practice in MA.

* Of course!

# IF YOU ARE EXPECTING TO RECEIVE PROCEEDS AND WOULD LIKE YOUR PROCEEDS WIRED, PLEASE COMPLETE THIS FORM IN ITS ENTIRETY

## PLEASE NOTE THAT A WIRE FEE OF $50.00 WILL APPLY

This form must be filled out in its entirety to ensure a timely wire. Hudkins Law is unable to transmit a wire unless all of the data fields on this form have been completed and verified.

Name of Wire recipient:___

Phone Number where you may be reached on the date of the expected wire:

<table border="1"><tr><td>Name of Receiving Bank</td><td></td></tr><tr><td>ABA Routing Number of Receiving Bank(9 digit number)*This may not be the routing number listed onthe bottom of your checks.Please call your bankto verify the number used to receiving anincoming wire*</td><td></td></tr><tr><td>Address of Receiving Bank</td><td>Street:City/State/Zip:</td></tr><tr><td>Phone Number of Receiving Bank</td><td></td></tr><tr><td>Account Number</td><td></td></tr><tr><td>Name(s) on Your Account</td><td></td></tr><tr><td>Address Associated with Your Account(Physical Address;not P.O.Box)</td><td>Street:City/State/Zip:</td></tr><tr><td>If Applicable,Provide Additional InstructionsHere.Example:“For Further Credit to”or“For the Benefit of”</td><td></td></tr></table>

By signing this form, I hereby acknowledge that the information is correct and accurate and I agree to the wire fee of $50.00. I further agree to verify this information by telephone or in person on the date of the wire transmission.

I understand that the receiving bank may charge an incoming wire fee to my account.

Hudkins Law PLLC hereby reserves the right to initiate a "test" wire for a nominal amount to confirm the accuracy of these wiring instructions. I agree to cooperate with the verification of receipt of said "test" wire.

<table border="1"><tr><td>Signature</td><td>Date</td><td>Signature</td><td>Date</td></tr></table>

Internal Use Only:

___ Telephone Verification by___ Date/Time:___

___ In Person Verification by___ Date/Time:___