CONSENT TO RECEIVE FAXES

For Corporations, Partnerships, etc.

Due to new federal regulations, your ability to receive faxes from us will be severely restricted as of July 1, 2005. To comply with these restrictions and continue to be able to received faxed information from us, we need your signature on the form below, with all applicable spaces filled in, and returned by fax to the number at the bottom of the page.

I am authorized by ________________________________________________ doing business

                                                (Insert legal name of corporation, partnership, etc.)

as: __________________________________________, to give its consent to receive faxes from

Berkeley's Northside Travel, Inc and any of its subsidiaries and affiliates directed to any of the

Following fax numbers, which it owns or controls:

___________________, ___________________, ___________________,

___________________, ___________________, ___________________.

 

I hereby grant such consent for all purposes:

 

_______________________________

(Signature)

_______________________________

(Print Name)

_______________________________

(Title)

 

_______________________________

(Date)

 

Return by fax to: 510-843-7537

Note:  Please print this form, fill it up and faxed the completed form back to us at 510-843-7537. Thank you.