CANADAPAYLESSRX LIMITED POWER OF ATTORNEY & RELEASE FORM

By Clicking I agree, it serves as your signed agreement to this Limited Power of Attorney & Release Form.

1. The Client is of the age of majority in the jurisdiction of which the Client ordinarily resides ("Place of Residence")

2. The Client is not restricted from making his or her own medical decisions under the laws of the Place of Residence of the Client.

3. The Client fully understands that it would be a violation of the law to falsify information on their medical questionnaire for the purpose of obtaining prescription medication. The Client agrees to truthfully and to the best of their knowledge answer all questions on their medical questionnaire.

4. The Client confirms that Paylessmeds.com and Paylessmeds Pharmacy (hereinafter "The Providers") that the pharmaceutical(s) ordered by the Client ("the Ordered Product") were prescribed by a duly qualified medical practitioner in the place of residence of the Client.

5. The Client has not violated any laws in the Place of Residence of the Client, in obtaining the prescription for the Ordered Product.

6. The Client confirms that the Ordered Product will not be used in any way whatsoever, except as prescribed by the duly qualified medical practitioner who originally issued the Prescription to the Client ("the Client's Doctor") and that duty of care is the responsibility of the Client's Doctor.

7. The Client confirms that no person other than the Client will use the Ordered Product.

8. The Client grants Limited Power of Attorney to the Providers, for the limited purpose of signing any documents as required by the laws of the Province of Manitoba (Canada), which are necessary to permit the delivery of the Ordered Product to the Client, in the same manner as the Client could, if the Client had personally attended the Providers place of business in Winnipeg,
Manitoba, Canada.

9. The Client attorns to the jurisdiction of Manitoba and agrees that any dispute that arises between the Client and the Providers shall be heard by the courts in Manitoba, Canada.

10. The Client acknowledges that the Ordered Product may not be returned for a refund or an exchange.

BY SIGNING THIS DOCUMENT THE CLIENT CONFIRMS THAT HE/SHE HAS READ AND UNDERSTOOD THESE TERMS AND THAT THEY ARE TRUE AND CORRECT AND THE CLIENT AGREES THAT THE TERMS HEREIN ARE BINDING ON THE CLIENT AND THE HEIRS ASSIGNS, SUCCESSOR AND PERSONAL REPRESENTATIVES OF THECLIENT.