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Form 133.7 - Application For Registration Of Securities, Section 7, Article 581, Vernon'S Annotated Civil Statutes The Texas Securities Act

Form

133.7

Texas State Securities Board

P.O. Box 13167

Austin, Texas 78711-3167

Application for Registration of Securities,

Section 7, Article 581, Vernon’s Annotated Civil Statutes

The Texas Securities Act

ANSWER ALL QUESTIONS. IF NOT APPLICABLE, SO STATE.

Name of applicant. If the applicant is not the issuer, state the capacity in which the

application is made (e.g., licensed dealer):

Correspondent:

Firm:

Address:

Telephone:

(_______)

Name of Issuer:

(a)

Address of Issuer’s principal office:

(b)

Address of Issuer’s principal office in Texas:

Is the filing under the Texas Securities Act, Section 7.A

, 7.B

, or 7.C

NOTE: An applicant filing under the Texas Securities Act, Section 7.A, is cautioned to

observe the audited financial statement requirements of Sections 7.A(1)f and 7.D, unless

the issuer is a “small business issuer” as defined in Rule 113.5. (See Rule 113.5 for

financial statement requirements.)

Date of Issuer’s fiscal year end:

Form 133.7 - Application For Registration Of Securities, Section 7, Article 581, Vernon'S Annotated Civil Statutes The Texas Securities Act