Form Va-1 Notice Of Limited Offering Of Securities (Page 5 of 5) in pdf

Form Va-1 Notice Of Limited Offering Of Securities Page 5

(c)

Are any proceeds of this offering to be escrowed pending completion of this offering?

Yes _____

No _____

(1)

If "yes", identify the escrow agent:

____________________________________________________________

Name

____________________________________________________________

Address

_______________________________________(____)________________

City, State, Zip Code

Telephone Number

(2)

If "yes", will the escrow account be:

_____

entire proceeds of offering; or

_____

partial proceeds of offering.

(3)

If "yes", describe the duration, e.g., "until completion of the offering" or "until

partial proceeds stated in Paragraph 2 are raised", and terms regarding interest,

indicating for whose benefit any interest will accrue.

NOTICE TO PROSPECTIVE INVESTORS:

IF THE ENTIRE PROCEEDS ARE NOT TO BE

ESCROWED PENDING COMPLETION OF THE OFFERING, PROSPECTIVE INVESTORS ARE

WARNED THAT THEIR TOTAL INVESTMENT MAY BE LOST OR EXPOSED TO CLAIMS OF

CREDITORS OF THE ISSUER IF THE ISSUER IS UNSUCCESSFUL IN COMPLETING THE

OFFERING.

SIGNATURE:

Applicant’s Signature:

____________________________________________________________________________________

Name (please print): ___________________________________________________________________

Title: _______________________________________________________________________________

Date of Notice: _______________________________________________________________________

Form Va-1 Notice Of Limited Offering Of Securities Page 5