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If you are interested in immediately engaging us please complete and mail the following form. Upon receipt we will contact you to discuss your city of interest and will help you start investigating store locations.

REFUNDABLE DEPOSIT

This deposit is paid by _______________ in the amount of $5,000.00.


Address of the depositor is:


_____________________________________________________


Check number: _________________________________________


Telephone number: ______________________________________

It is understood and agreed upon that this deposit is 100% refundable if the proper location for a store is not found or if financing is necessary and cannot be secured. This deposit is reduced by the cost of all traveling and/or site location work done by Dollar Store Services, Inc. in helping you attempt to find store locations, if any.

______________________________________ ______________
Signature of Deposit Maker Date

______________________________________ ______________
Received by the Company Date

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Dollar Store Services
4505 West Hacienda Ave., Suite I
Las Vegas, NV 89118

1-800-829-2915
FAX: 1-702-382-8454
TEL: 1-702-382-8444
Email: sales@dollarstoreservices.com
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