Form Rq - Application For Registration Of Securities By Qualification - Alabama Office Of The Securities Commission Page 4

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Item 10.
List the maximum amount of commissions and all other expenses, directly or
indirectly, for or in connection with the proposed distribution of the issuer’s securities:
(a) Underwriting Discounts and Commissions
$
(b) Printing and Engraving
(c) Legal Fees and Expenses
(d) Accounting Fees and Expenses
(e) Finders Fees
(f) Value of Warrants and Options to Underwriters
(g) Securities and Exchange Commission Filing Fee
(h) State Filing and Registration Fees and Expenses
(i)
Miscellaneous: (describe) __________________
Total
PART II
Applicant
shall
furnish
the
following
exhibits,
where
applicable,
properly
numbered:
Exhibit 1.
Submit 6 copies of the prospectus or offering circular, 6 copies of all amended
prospectuses with 1 copy red-lined to indicate changes and 6 copies of the final
prospectus, 1 copy of any Registration Statement, letter or notification or any
similar filing made with the Securities and Exchange Commission if applicable.
Submit Commission Exhibit Form 1 for an offering where a Registration Statement
or Regulation A Notification has not been filed with the Securities and Exchange
Commission.
Exhibit 2.
Occupational affidavits of officers, directors, partners, trustees and controlling
persons on Commission Form 1-A.
Exhibit 3.
Issuers Bond pursuant to Section 34 (c).
Exhibit 4.
Copy of Articles of Incorporation including amendments thereof, certified by a
corporate officer, if issuer is a corporation; or of articles of association, or of
partnership or of the instrument under which a trust is created or declared, if issuer
is a trust.
Exhibit 5.
By-Laws of Issuer certified by a corporate officer, including all amendments.
4

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