Fax Cover Sheet

Please fill out the indicated fields below, then click "Print" to generate a hard copy of this Fax Cover Sheet.

To:

EverestPoker.fr

Attention:

Account Validation Dept.

Fax Number:

Date:

4-8-2010 19:32:58 GMT

Type Full Name:

Account Login Name:

Account Email Address:

File ID:

(Please write your file ID on your other fax pages to ensure swift processing of your documents.)

Authorized Signature:

Please sign your name in this box after printing out the cover sheet

Number of pages including cover:

Contents Checklist:

Copy of government-issued ID

Copy of RIB

Message:

Type your optional message here.