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Affiliation Form for

Businesses and Services with

Please fill out the below form, select the affiliation plan and send it (fax) to our offices or contact us directly.

Information

Name of the Company:

Contact Person:

Address:

P.O. Box:

Phone:

E-mail:

Fax:

Website:

Comments:

Your contact person at 1 - CostaRicaLink:

Options of Affiliation

◊ Plan -A ( 6 month $30.00 ) ◊ Plan – B with 10% discount ( 1 year $54.00 )

Ways of Payment

◊ Check (made out to 1 - CostaRicaLink S.A)

◊ Deposit or bank transference made out to one of the following accounts. Please send fax

of the deposit-slip to 2288--3472 indicating the name of your business.

Bank Accounts in the name of 1 - CostaRicaLink S.A.
Banco San José cuenta corriente	$ 902488683
Banco San José cuenta cliente	$ 10200009028483321
Banco Nacional cuenta corriente	$ 100-02-009-600076-5
Banco Nacional cuenta cliente	$ 15100910026000768
Banco de Costa Rica cuenta corriente	¢ 325-319-0
Banco de Costa Rica cuenta cliente	¢ 15201325000031900

For additional information please contact s at

1 - CostaRicaLink S.A. Apartado 497-6150 Santa Ana, Tel. 2288-3415 / Fax: 2288-3472

E—mail: 1-costaricalink@flamingo-link.com Website: www.1-costaricalink.com