Form C - Undertaking - Quarterly Reports - Colorado Department Of Regulatory Agencies Page 6

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i.
List the amount of securities purchased and the amount of funds
invested by each purchaser in this offering.
ii.
Include the date(s) of purchase(s).
iii.
Include the legal address of each purchaser.
Item G.
Other Events.
The Registrant shall report under this Item G any material events
with respect to which information is not otherwise called for by this
quarterly report.
DATED this _______ day of _______________________, 20____.
________________________________
(Name of Registrant)
________________________________
(Name and position of duly authorized
signing officer)
___________________________________
(Director)
___________________________________
(Director)
___________________________________
(Director)
(Rev. 5/2000)
6

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