Request for Service

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04200840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>DCH Marine Inc.     </B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="DCH Marine Inc. "><U><B>home</B></U></A></div> <div> <A HREF="id10.htm" TARGET="_top" TITLE="Prices "><U>Prices     </U></A>   |   <B>Request for Service</B>   |   <A HREF="id16.htm" TARGET="_top" TITLE="Limitations and Restrictions"><U>Limitations and Restrictions</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Owner Consent Form"><U>Owner Consent Form</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="03c11c00egdysm.png"> <div> <A HREF="index.htm" TARGET="_top" TITLE="DCH Marine Inc. "><U><B>Home</B></U></A></div> <div> <A HREF="id10.htm" TARGET="_top" TITLE="Prices "><U><B>Prices</B></U></A></div> <div> <B>Request for Service</B></div> <div> <A HREF="id16.htm" TARGET="_top" TITLE="Limitations and Restrictions"><U><B>Limitations and Restrictions</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Owner Consent Form"><U><B>Owner Consent Form</B></U></A></div> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B>Please print, fill out and fax to (954) 862-5993 to request our services. </B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Request for Service</div> <div> <IMG SRC="06364180.png" border=0 width="612" height="792" ALT="Adobe Acrobat Document" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </td> </tr></table></body>