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Safe Streets USA LLC Express Written Consent Form MARKETING AUTHORIZATION: I, the undersigned, hereby authorize Safe Streets USA, LLC (“Safe Streets”), directly or through its affiliates and marketing partners, to contact me from time-to-time by telephone, text, email and/or direct mail with information and offers about products and services that might interest me. By clicking contact me below, I hereby authorize the receipt of such solicitations at the telephone number(s), (including cellular numbers), emails address(es) and/or mailing address(es) shown below, even if such telephone number(s), email address(es) or mailing addresses are listed on any “do not call” or other do not solicit registry or list and I agree that any such telephone calls and text messages may be generated using an automated phone dialing system. To discontinue or opt out of text messages reply with stop. I understand I am not required to consent to make a purchase.

If you previously registered with a different GTR customer, you agree to be transitioned to SafeStreets

License Numbers: Safe Streets USA License Numbers: WA SAFESSU854P8, EC SAFESSU846BO NM 387294 TX B06239001 ACR-2072317 CO 2015-BFN-0008204 AL AESBL #993 AR Safe Streets License # CMPY.0002025 CT CLELC.0185208-L5 DC BL602511000104 DE BA11-201 FL BAEG13000404 GA BLLVA205866 IA BAAC0129 IL BA127001452 IN BALAC000190 MD BA107-1680, 16368955, 1352811, 01981855 MI BA3601206276 MN BATS02343 MS BA15013023, 10429325 NC BL624CSA NJ BA34BF00018800, 13VH06160200 NY BA12000302109 PA CL PA024334 SC BABAC 13455 TN BA0000-1611 VA BA11-6617, 2705139266 WV BAWV047939 NV 0081024 AZ 302967, 19898 LA F2164 OK AC440557 UT 9439243-6501 CA 1031324, ACO7817 ID RCE-40579,037665 OH 53.89.1866 AK 1074625, 136835 MT PSP-ELS-LIC-30523 WY C-48775 CT HIC.0652291 NH 0463C