Soi Supplement Form - State Of Pennsylvania printable pdf download

Soi Supplement Form - State Of Pennsylvania

NOTE TO USERS: The following form sets forth the minimum informational requirement for soliciting

indications of interest under the Pennsylvania Securities Act of 1972 (1972) when used in conjunction with

Form SOI. You may include additional information if you think it necessary or desirable. Remember that

any discussion in this document is subject to the anti-fraud provisions of the 1972 Act and must therefore

be complete. You may not exaggerate the investment opportunity, minimize the risks of the enterprise or

predict revenues, profits or payment of dividends (including financial projections and forecasts). The

information in the Pennsylvania SOI Supplem ent is an integral part of the SOI Form and MUST

accompany the SOI Form inform ation at all times and under all circumstances.

PENNSYLVANIA SOI SUPPLEMENT

NAME OF COMPANY

Check the appropriate response(s))

1. The issuer's revenues during the last full fiscal year were:

Less than $10,000

$10,000 or more but less than $50,000

$50,000 or more but less than $250,000

$250,000 or more but less than $1 million

$1 m illion or more

Issuer has been in existence for less than a full fiscal year

The issuer had a profit or loss during its last full fiscal year of:

PROFIT OF:

Less than $10,000

$10,000 or more but less than $50,000

$50,000 or more but less than $250,000

$250,000 or more

LOSS OF:

Less than $10,000

$10,000 or more but less than $50,000

$50,000 or more but less than $250,000

$250,000 or more

Issuer has been in existence for less than a full fiscal year

The average price per share of stock paid in cash by the issuer's current shareholders was:

Less than $.01

$.01 or more but less than $.05

$.05 or more but less than $.10

$.10 or more but less than $.25

$.25 or more but less than $1.00

$1.00 or more

Soi Supplement Form - State Of Pennsylvania