Millstone Development Corporation

Suite 337, 14032 – 23 Avenue Edmonton, Alberta T6R 3L6

Telephone : 780 – 982 – 6805 Fax : 780 – 440 – 5166

www.millstonedevelopmentcorporation.com

DIRECT DEPOSIT INSTRUCTIONS

Name : The Marketplace of Ponoka

Investor Information :

Last Name : ___________________________________________

First Name : ___________________________________________

Address : ___________________________________________

___________________________________________

City : __________________________ Province : ___________________________

Postal Code : __________________________ Country : ___________________________

Telephone Number : __________________________ Email : ____________________________

Bank Account Information

Financial Institution : ________________________________________________

Branch Address : ________________________________________________

________________________________________________

Transit # : ________________________________ Bank Code ____________________________

Account Number __________________________________________

I, ____________________________________________, authorize Millstone Development Corporation to credit my

bank account for the monthly interest payments. I will notify Millstone Development Corporation in writing if I decide to
rescind this direct deposit request or make other changes to my account.

Authorized by ___________________________________________ Date ____________________________

Note : Please provide a cheque marked “void “ to ensure the correct information when applicable.