Application For Reservation - Arizona Corporation Commission Page 3

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REQUIRED - you must complete and submit with the Articles a

Certificate of

Disclosure.

The Articles will be rejected if the Certificate of Disclosure is not simultaneously submitted.

10. INCORPORATORS - list the name and address, and provide the signature, of each and

every incorporator - minimum of one is required. If more space is needed, check this box

and complete and attach the

Incorporator Attachment

form C084.

Name

Address 1

Address 2 (optional)

City

State

Zip

City

State

Zip

Country

SIGNATURE –

see Instructions C010i:

By checking the box marked "I accept" below, I acknowledge

under penalty of perjury that this document together with

any attachments is submitted in compliance with Arizona law.

I ACCEPT

Signature

Printed Name

Date

Printed Name

Date

IF SIGNING FOR AN ENTITY, CHECK ONE, FILL IN BLANK:

Corporation as Incorporator - I am signing as an

officer or authorized agent of a corporation and its

name is:

LLC as Incorporator - I am signing as a member,

manager, or authorized agent of a limited liability

company , and its name is:

company, and its name is:

Mail:

Arizona Corporation Commission

Filing Fee: $60.00 (regular processing)

Corporate Filings Section

Expedited processing – add $35.00 to filing fee.

1300 W. Washington St., Phoenix, Arizona 85007

All fees are nonrefundable - see Instructions.

Fax:

602-542-4100

Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain to

the individual needs of your business.

All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.

If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.

C010.002

Arizona Corporation Commission – Corporations Division

Rev: 2013

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