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(Printed First and Last Name) (Printed First and Last Name <br /> (Printed First and Last Name) (Printed First and Last Name <br /> (Printed First and Last Name) (Printed First and Last Name <br /> THIS A UTHPRIZATION MUST BE"ZtGNED BY'AN OFFICER' AUTHORIZED MANAGER,OF,THE COMPANY <br /> Authorized By: <br /> (Print Name) (Signature) (Title) (Date) <br /> This document is confidential and contains the names of those individuals who are authorized to access any and all records stored at Starpoint Global Services.This information is intended only <br /> for the use of those individuals.Do not copy or distribute.To maintain security of your records please notify us immediately of any and all changes using this form.Changes become effective 24 <br /> hours after receipt of Original Copy.Fax and photocopies cannot be accepted. <br /> Page 23 <br />