Customer Order Application Form

TMT, P.o.Box 3155, Renton WA 98056

Sender information

Name: City:

Address: ____________________________________________ State____ Zipcode _____________

Telephone: Cell-phone: E-mail:

Recipient Information

Name: ,Telephone:

City: Country :

Transferred Amount: ____________________Dollars TMT Charges: $___________Dollars

Grand Total $ _________________Dollars

Type of transaction requested:

Nakfa USD (For USD fill out the following bank information)

I request TMT to deposit the money in the following recipient’s bank account:

Bank name Bank branch Bank account

I will pay by: Check Check by phone Money order

Signature: Date:

*** If amount is more than $1000 you must sign this form in front of a notary ****

CERTIFICATE OF ACKNOWLEDGMENT

State of: _____________________________, County of ________________________,

On _________, 20 _____ before me, _____________________________ Notary Public in and for said

county, personally appeared _____________________________________________________,who has satisfactorily identified him/herself as the signer to the above-referenced document.

Notary Stamp here:

My Commission Expires _____________, _________________, _______________

(Expiration date) (Notary Signature) (Date)

TMT is a licensed Money Service Business registered in Washington State.

Tel: 1-425-227 7762 Fax:1-425-255 0345 E-mail: transhorn@ertra.com