This Investment Representation Letter is used when a company is selling securities and is relying on specific exceptions to having register the securities with the SEC. With the letter, the prospective shareholder (investor) furnishes confidential and personal information to a company in order to invest. This letter, which precedes the investment, is for use by an individual or entity.

The information provided in this letter includes the investor's name, occupation and net worth. It also includes a provision that states that the investment is for shareholder's use only, or as fiduciary on behalf of another. Language to be printed as a legend on the share certificate is supplied within in this letter.

This Investment Representation Letter includes:

• Parties: Sets forth the name of the company and shareholder who will purchase stock f the company;
• Institutional/Individual Shareholders: Requests specific information from shareholders who are individuals or institutions including name, address, social security number and net worth;
• Non-accredited Investors: Requests specific information from this type of investor including credentials and net worth information;
• Signatures: An officer of the company must sign this letter.

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This attorney-prepared packet contains:

1. General Information
2. Instructions and Checklist
3. Investment Representation Letter

State Law Compliance: This form complies with the laws of all states