Form 8q - Registration By Qualification Page 3

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Official Use ONLY
Control #:_______________
Examiner:_______________
APPLICANT:_______________________________________
C.
Forecasts and Projections
15. LITIGATION, MATERIAL
A.
Issuer
B.
Officers, Directors, Affiliates
16. NEGOTIABLE INSTRUMENTS
17. PROSPECTUS
A.
Draft Copy
B.
Three Final Dated Copies
C.
Sales Literature
D.
Literature for Selling Group
18. RISK FACTORS
A.
Competition
B.
Litigation
C.
Conflicts
D.
Key Officials
E.
Investigative Proceedings
F.
Market Conditions
G.
Tract Record
H.
Dilution
19. SELLING SHAREHOLDERS
A.
Name and Address
B.
Amount of Securities Owned
C.
Relationship to Issuer
20. SPECIMEN OF SECURITIES TO BE ISSUED
21. STOCK/SECURITY OPTIONS DESCRIPTION
22. STOCK SUBSCRIPTION AGREEMENT
23. UNDERWRITING OR SELLING GROUP AGREEMENT
24. USE OF PROCEEDS
3

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