DTAF Placement Partner Agreement

______________________________________     ____________________

Name of Organization                                                Phone

_____________________________________________________________

Address

______________________________________     ____________________

Main Contact                                                                                       Phone

_____________________________________________________________

Address

If there is more than one contact, please attach an additional sheet of paper with the appropriate information to this agreement.

I agree to abide by the policies set forth in this brochure and have enclosed all necessary documents listed in> 11A-D needed to process this agreement.

______________________________________       ____________________

Signature of Representative                                                  Date

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Internal Use Only

Date:__________                                Reference:________________________________

Reference Type:_________________________________________________________________________

Comments:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Approved By:____________________________       Date________________