Solicitation Of Interest Form
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1
2Solicitation of
ROSS MILLER
Interest Form
Secretary of State
555 East Washington Ave., #5200
NAC 90.538
Las Vegas, Nevada 89101
Phone (702) 486-2440
State of Nevada
Fax (702) 486-2452
PAGE 1
Website:
ABOVE SPACE FOR OFFICE USE ONLY
Name of Issuer:
Address of Principal Office:
Street Address
City
State
Zip Code
Issuer Phone Number:
Date of Organization:
Amount of
Name of Chief
Proposed Offering:
Executive Officer:
THIS IS A SOLICITATION ONLY:
l
No money or other consideration is being solicited and none will be accepted.
l
No sale of the securities will be made or commitment to purchase accepted until the delivery
of a final offering circular that includes complete information about the issuer and the offering.
l
An indication of interest made by a prospective investor involves no obligation or commitment
of any kind.
l
This offer is being made pursuant to an exemption from registration under the federal and state
securities laws. No sale may be made until the securities are registered or exempt in the state
of Nevada.
l Neither federal nor state authorities have confirmed the accuracy or determined the adequacy
of this document or any other document presented to you in connection with this Solicitation of
Interest.
THIS COMPANY:
Has never conducted business operations.
Is in the development stages.
Is currently conducting operations.
Has shown a profit for the last fiscal year.
Other (specify)
BUSINESS
1. Describe in general what business the company does or proposes to do, including what products or goods are
or will be produced or services that are or will be rendered*:
2. Describe in general how these products or services are to be produced or rendered and how and when the
company intends to carry out its activities*:
* If additional space is needed, please attach page to this form.
Nevada Secretary of State Solicitation of Interest Form Page 1
Revised 12-17-10
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