Claim Form Approval

<BODY BGCOLOR="#000000" TEXT="#F7F7FF" LINK="#FFCC99" ALINK="#009D74" VLINK="#FF9966"> <div> <FONT SIZE="5" COLOR="#CC3300" FACE="Baskerville Old Face" ><B>America's Family Entertainment, Inc.</B></FONT><FONT SIZE="1" COLOR="#FFCC99" FACE="Baskerville Old Face" > </FONT><FONT SIZE="1" COLOR="#FFCC99" FACE="Arial" >   </FONT> |   <A HREF="index.htm" TARGET="_top" TITLE="Americas Family Entertainment, Inc."><U><B>home</B></U></A></div> <div> <A HREF="id35.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="News and Events"><U>News and Events</U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Locations"><U>Locations</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE=" Products and Services"><U>  Products and Services</U></A>   |   <A HREF="id83.htm" TARGET="_top" TITLE="Promotions"><U>Promotions</U></A>   |   <A HREF="id59.htm" TARGET="_top" TITLE="SkyTracker® News"><U>SkyTracker® News</U></A>   |   <A HREF="id57.htm" TARGET="_top" TITLE="SkyTracker®"><U>SkyTracker®</U></A>   |   <A HREF="id47.htm" TARGET="_top" TITLE="Business Rules"><U>Business Rules</U></A>   |   <A HREF="id63.htm" TARGET="_top" TITLE="Company Prospectus"><U>Company Prospectus</U></A>   |   <A HREF="id98.htm" TARGET="_top" TITLE="_"><U>--Type Title Here--</U></A>   |   <A HREF="id66.htm" TARGET="_top" TITLE="Customer/Dealer Work Order"><U>Customer/Dealer Work Order</U></A>   |   <A HREF="id75.htm" TARGET="_top" TITLE="Dish Installation Checklist"><U>Dish Installation Checklist</U></A>   |   <B>Claim Form Approval</B>   |   <A HREF="id69.htm" TARGET="_top" TITLE="AFEXpress Satellite Internet"><U>AFEXpress - Satellite Internet</U></A>   |   <A HREF="id92.htm" TARGET="_top" TITLE="AFEXpress Approval Form"><U>AFEXpress Approval Form</U></A>   |   <A HREF="id93.htm" TARGET="_top" TITLE="AFEXpress Waiver"><U>AFEXpress Waiver</U></A>   |   <A HREF="id76.htm" TARGET="_top" TITLE="AFEXpress Checklist"><U>AFEXpress Checklist</U></A>   |   <A HREF="id70.htm" TARGET="_top" TITLE="Internet Agreement"><U>Internet Agreement</U></A>   |   <A HREF="id48.htm" TARGET="_top" TITLE="Dealer Agreements"><U>Dealer Agreements</U></A>   |   <A HREF="id60.htm" TARGET="_top" TITLE="Dealer Economics"><U>Dealer Economics</U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="Becoming a Dealer"><U>Becoming a Dealer</U></A>   |   <A HREF="id62.htm" TARGET="_top" TITLE="Dealer Incentives"><U>Dealer Incentives</U></A>   |   <A HREF="id85.htm" TARGET="_top" TITLE="Coop Advertising"><U>Co-op Advertising</U></A>   |   <A HREF="id86.htm" TARGET="_top" TITLE="Coop Advertising PreApproval Form"><U>Co-op Advertising Pre-Approval Form</U></A>   |   <A HREF="id91.htm" TARGET="_top" TITLE="Advertising Disclaimers"><U>Advertising Disclaimers</U></A>   |   <A HREF="id68.htm" TARGET="_top" TITLE="Stockholder News"><U>Stockholder News</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="FAQ (commissions) "><U>FAQ (commissions) </U></A>   |   <A HREF="id84.htm" TARGET="_top" TITLE="LP/GAS Magazine"><U>LP/GAS Magazine</U></A></div> <div> <IMG SRC="04658020.gif" border=0 width="600" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <U>Claim Form Approval</U></div> <div> America's Family Entertainment, Inc.</div> <bR> <div> __________________________________</div> <div> ( Your Company Name)</div> <bR> <div> Twelve Month Contract:____________________           Free Installation ______________</div> <bR> <bR> <div> Customer Name:__________________________________________________________</div> <bR> <div> Customer Address:________________________________________________________</div> <bR> <div> City:_______________________________  State:_______________________________</div> <bR> <div> Zip:_______________________</div> <bR> <div> Telephone: (___)________________________________</div> <bR> <div> Social Security # _______________________________</div> <bR> <div> Credit Card # __________________________________</div> <div> (All major credit cards accepted, <U>no</U> Debit cards)</div> <bR> <div> Expiration Date Month/Year___________/___________</div> <bR> <div> Promotion ___________________________________________________________________________</div> <bR> <div> ROO # ___________________________________  SOO/SOOO # ______________________________</div> <bR> <bR> <div> Customer Signature:________________________________________     Date: ____________________</div> <bR> <bR> </BODY>