CANTRUSTRX INC. LIMITED POWER OF ATTORNEY & RELEASE FORM

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

THE UNDERSIGNED, BEING OVER THE AGE OF 21, HEREBY:

1. Represents and confirms CanTrustRx Inc., along with its subsidiaries and affiliates (herein collectively "CanTrust") that the pharmaceutical(s) to be delivered to the undersigned were prescribed by a doctor licensed to practice medicine in the country, state, or other applicable jurisdiction in which the undersigned resides, that the prescription(s) for the pharmaceutical(s) were lawfully obtained from that physician and that the pharmaceutical(s) will be used only as directed and only by the person for whom the pharmaceutical was prescribed.
   
2. Acknowledges that CanTrust and CanTrust's employees and agents have relied on the information and documentation provided by the undersigned (including the Patient Questionnaire) and the undersigned represents and confirms that the undersigned has, to the best of his/her knowledge, fully disclosed all pertinent requested information and documentation to CanTrust. The undersigned undertakes to notify CanTrust of any changes to his/her physical or medical condition by providing an updated Patient Questionnaire.
   
3. Understands that it is the undersigned's responsibility to have regular physical examinations by the licensed physician whose care he/she is under, including all suggested testing by said physician to ensure the undersigned has no medical problems, which would constitute a contradiction to him/her taking the medication(s) being prescribed.
   
4. Authorizes and appoints CanTrust, as his/her agent and his/her attorney for the limited purposes of taking all steps and signing all documents on behalf of the undersigned necessary to obtain a prescription in Canada for the prescription sent by the undersigned to CanTrust, to the same extent as the undersigned could do if he/she were personally present taking those steps and signing those documents himself/herself, including, but not limited to, collecting personal health information regarding the undersigned directly from his/her prescribing physician or pharmacist and disclosing personal health information to CanTrust employees, agents and service providers, as required, for the limited purposes set out above.
   
5. Authorizes and appoints CanTrust as his/her agent and his/her attorney for the purpose of taking all steps and signing all documents on behalf of the undersigned necessary to package or repackage the pharmaceutical(s) and to deliver them to the undersigned, to the same extent as the undersigned could do if he/she were personally present taking those steps and signing those documents himself/herself.
   
6. Authorizes and appoints CanTrust, as his/her agent and as his/her attorney for the purpose of taking all steps and signing all documents on behalf of the undersigned for shipping his/her prescribed pharmaceutical(s) to the undersigned as if the undersigned had shipped the prescribed pharmaceutical(s) to himself/herself to the undersigned's address.
   
7. Acknowledges and agrees that the undersigned initiated a consultation with CanTrust. The undersigned acknowledges that the pharmacists working for CanTrust and the physicians contracted by CanTrust on the undersigned's behalf are located and licensed to practice medicine or pharmacy in Canada and that all treatment the undersigned is receiving from the said physician and pharmacist is being received in Canada.
   
8. Acknowledges and agrees that any and all agreements reached or contracts formed throughout the course of the relationship between the undersigned and CanTrust shall be deemed to be made in Manitoba, and accordingly shall be governed by the laws of the Province of Manitoba and the laws of Canada as applicable to such contracts and agreements.
   
9. Agrees that any dispute that arises between him/her and CanTrust, its affiliates, related companies, subsidiaries, parent company, officers, directors, employees or agents shall be governed by the laws of the Province of Manitoba and the laws of Canada applicable to contracts formed in Manitoba and the undersigned agrees that the Courts of the Province of Manitoba shall have sole and exclusive jurisdiction over any such dispute.
   
10. Understands that CanTrust shall be entitled to substitute a prescription drug with a generic drug, where available in accordance with the Manitoba Drug Standards and Therapeutic Formulary, unless the physician has indicated that there be "no substitution".
    
11. Acknowledges and understands that once purchased and shipped, no pharmaceutical product may be returned or exchanged.

LEGAL DISCLAIMER AND PRIVACY
Terms and Conditions of Use

CanTrustRx Inc., along with its subsidiaries and affiliates (herein collectively "CanTrust"), provides the information and services on its Web site (the "Site") under the following terms and conditions. By accessing and/or using the Site, you ("User") indicate your acceptance of these terms and conditions.

LAWS AND REGULATIONS. Access to and use of this Site are subject to all applicable international, federal, provincial, state and local laws and regulations. User agrees not to use the Site in any way which violates such laws or regulations.
COPYRIGHT AND TRADE-MARKS. The information available on or through this Site is the property of CanTrust, and is protected by copyright, trade-mark, and other intellectual property laws. Users may not modify, copy, distribute, transmit, display, publish, sell, license, create derivative works or otherwise use any information available on or through this Site for commercial or public purposes. Users may not use the trade-marks, logos and service marks ('Marks") for any purpose including, but not limited to use as "hot links" or meta tags in other pages or sites on the World Wide Web without the written permission of CanTrust or such third party that may own the Mark.
TAMPERING. User agrees not to modify, move, add to, delete or otherwise tamper with the information contained in this Site. User also agrees not to decompile, reverse engineer, disassemble or unlawfully use or reproduce any of the software, copyrighted or trademarked material, trade secrets, or other proprietary information contained in the Site.
THIRD PARTY INFORMATION. Although CanTrust monitors the information on the Site, some of the information may be supplied by independent third parties. While CanTrust makes every effort to ensure the accuracy of all information on the Site, CanTrust makes no warranty as to the accuracy of any such information.
LINKS TO THIRD PARTY SITES. This Site may contain links that will let you access other Web sites that are not under the control of CanTrust. The links are only provided as a convenience and CanTrust does not endorse any of these sites. CanTrust assumes no responsibility or liability for any material that may be accessed on other Web sites reached through this Site, nor does CanTrust make any representation regarding the quality of any product or service contained at any such site.
LINKS FROM THIRD PARTIES. CanTrust prohibits unauthorized links to this Site and the framing of any information contained on this Site or any portion of this Site. CanTrust reserves the right to disable any authorized links or frames. CanTrust has no responsibility or liability for any material on other Web sites that may contain links to this Site.
NO WARRANTIES. Information and documents provided on this Site are provided "as is" without warranty of any kind, either express or implied, including without limitation warranties of merchantability, fitness for a particular purpose, and non-infringement. CanTrust uses reasonable efforts to include accurate and up-to-date information on this Site. It does not, however, make any warranties or representations as to its accuracy or completeness. CanTrust periodically adds, changes improves, or updates the information and documents on this Site without notice. CanTrust assumes no liability or responsibility for any errors or omissions in the content of this Site. User's use of this Site is at User's own risk.
LIMITATION OF LIABILITY. UNDER NO CIRCUMSTANCES SHALL CanTrust BE LIABLE FOR ANY DAMAGES SUFFERED BY YOU, INCLUDING ANY INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES (INCLUDING WITHOUT LIMITATION, ANY LOST PROFITS OR DAMAGES FOR BUSINESS INTERRUPTION, LOSS OF INFORMATION, PROGRAMS OR OTHER DATA) THAT RESULT FROM ACCESS TO, USE OF, OR INABILITY TO USE THIS SITE OR DUE TO ANY BREACH OF SECURITY ASSOCIATED WITH THE TRANSMISSION OF INFORMATION THROUGH THE INTERNET, EVEN IF CanTrust WAS ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
PRIVACY and SECURITY. Protecting the privacy of our clients and users of our Sites is important to CanTrust. Data transmitted to and from this Site is encrypted for the User's protection. However, the security of information transmitted through the Internet can never be guaranteed. CanTrust is not responsible for any interception or interruption of any communications through the internet or for changes to or losses of data. User is responsible for maintaining the security of any password, user ID, or other form of authentication involved in obtaining access to password protected or secure areas of this Site. In order to protect you and your data, CanTrust may suspend your use of this Site, without notice, pending an investigation, if any breach of security is suspected.
TRANSMISSION OF PERSONAL DATA. User acknowledges and agrees that by providing CanTrust with any personal information through the Site, User consents to the transmission of such personal user information over international borders as necessary for processing in accordance with CanTrust's standard business practices.ACCESS TO PASSWORD PROTECTED/SECURE AREAS. Access to and use of password protected and/or secure area of the Site is restricted to authorized users only. Unauthorized access to such areas is prohibited and may lead to criminal prosecution.
JURISDICTION/GOVERNING LAW. These terms and conditions shall be governed and construed in accordance with the laws of the Province of Manitoba and applicable federal laws without regard to conflicts of law principles. User agrees that any and all proceedings relating to this site and the subject matter contained herein shall be maintained in the courts of the Province of Manitoba or the federal courts sitting in the Province of Manitoba, which courts shall have exclusive jurisdiction for such purpose.

THE UNDERSIGNED HAS READ AND UNDERSTANDS THESE TERMS AND AGREES THAT THEY SHALL BE BINDING UPON THE UNDERSIGNED AND HIS/HER HEIRS, SUCCESSORS AND PERSONAL REPRESENTATIVES