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Form Rq - Application For Registration Of Securities By Qualification - Alabama Office Of The Securities Commission Page 6

The applicant hereby applies for registration of the above-described securities under Title 53,

Code of Alabama, and in consideration thereof agrees that it will:

(a)

Advise the Commission of any change in any of the information contained herein or

in any supporting documents submitted with or as a part of this application prior to

registration.

(b) Advise the Commission of any material adverse change in the financial condition or

business operations of the issuer during the period of distribution of the securities

sought to be registered herein.

(c)

File quarterly reports required by Section 34 (g) on Commission Form H.

(d) Amend the prospectus or offering circular pursuant to Rule 30-4.

(e)

Submit every advertisement or sales literature to be used in connection with the sale

of securities for authorization pursuant to Rule 65-6.

(f)

File with the Commission within two (2) business days after filing with the

Securities and Exchange Commission (i) all amendments to the federal registration

statement, letter of notification pursuant to Regulation A, Schedule D pursuant to

Regulation B, designating the revised or added material or information by

underlining the same; and (ii) the final prospectus, offering circular or Schedule D,

or any further amendments or supplements thereto.

(g) Notify the Commission within two (2) business d ays (i) upon the receipt of any stop

order, denial, order to show cause, suspension or revocation order, injunction or

restraining order, or similar order entered or issued by any state or other regulatory

authority or by any court, concerning the securities covered by this application or

other securities of the issuer or applicant to any other state or regulatory authority,

(ii) for permission to withdraw any application to register the securities covered by

this application,

and (iii) upon receipt of any notice of effectiveness of the

registration by the Securities and Exchange Commission.

(h) Furnish promptly all additional information and documents requested by the

Commission which are necessary to ascertain whether the securities shall be

registered under Title 53, Code of Alabama.

Signed (and officially sealed) this _________ day of _______________, 20______

Name of Applicant

Form Rq - Application For Registration Of Securities By Qualification - Alabama Office Of The Securities Commission Page 6