PACIFIC NORTH WEST
CAPITAL CORP.
Request for Interim Financial Statements
In accordance with National Instrument 54-101 of the Canadian Securities Administrators, registered and beneficial shareholders of the subject Company may elect annually to receive interim corporate mailings, including interim financial statements of the Company, if they so request. If you wish to receive such mailings, please complete and return this form to:
Pacific North West Capital Corp.
2303 West 41st Avenue
Vancouver, BC V6M 2A3
facsimile: 604-685-6550
NAME:
_____________________________________________________________
ADDRESS:
_____________________________________________________________
_____________________________________________________________
POSTAL CODE:
___________________________
TELEPHONE:
FACSIMILE:
EMAIL:
I confirm that I am an owner of common shares of the Company.
SIGNATURE OF
SHAREHOLDER:
______________________________________DATE:____________
CUSIP: 694 916 107
