NOTICE TO PRINCIPAL OF AGENCY TERMINATION

To: __________________________

__________________________ (Address)

__________________________

As stated in section ________________ of the agreement between us that was executed ______________ (Date), it is stated that the agreement is terminable by either party with _____________ days written notice to the other party, I hereby give written notice that I terminate and cancel our agency agreement dated _____________ (Date).

_________________________ _____________________

Signature Date

_________________________ _____________________

Signature Date