CLIENT__________________ SPOUSE__________________
CLIENT S.S.#_____________ SPOUSE S.S.#_____________
ADDRESS________________________________________________
OLD ADDRESS (if current is less than 2years)
_________________________________________________________

HOME PHONE#____________ WORK PHONE#___________

Client(s) agrees to pay the fee for services of Simpletouchgroup to be rendered: $100 per one correction.
Please pay via check, money order or cashier's check. Upon clearing the bank, your agreement will be in effect.
Any unpaid checks, money orders or cashier's checks will be considered a canceled agreement

CLIENT SIGNATURE________________________________
DATE__________________________
SPOUSE SIGNATURE________________________________
DATE__________________________

Simple Touch Group
4214 BEVERLY BLVD. STE 207
LOS ANGELES, CA 90004
TEL: 213-252-9550
FAX: 213-251-9890