Fill and Sign the Investment Letterintrastate Offering Form

Investment Letter regarding Intrastate Offering To:The Board of Directors of ________________________ (Name of Issuer of Securities) ________________________________ (Street Address of Post Office Number) ________________________________ (City, State and Zip Code) Ladies and Gentlemen: In connection with my purchase of _______ shares of the $__________ par value of common stock of _________________________ (Name of Corporation) , Certificate No. ____________, I represent to you that I am acquiring such shares for investment for my own account and not with a view to distribute, resell or otherwise transfer such shares. Further, I do not intend to resell or otherwise dispose of any or all such shares unless and until I determine at some future date that changed circumstances, not now contemplated, make such disposition advisable. Prior to such transfer, I will deliver to you a written opinion of counsel stating that both state registration requirements and registration requirements under the Securities Act of 1933 have been or are being met, or that an exemption from such registration is available and that the sale may proceed without violating either the state or federal Securities Acts. I also represent to you I am a bona fide resident of the State of ______________ and I understand that if I decide to sell at any future date that I will sell these shares only to other residents of the State of ______________. I agree that you may include a stock transfer restriction on these shares for a period of nine months after the date of the last sale of this issue by the corporation and that you may place a legend on the certificate stating that the securities have not been registered under the Securities Act of 1933 and setting forth the limitations on resale. You may issue stop transfer instructions to your transfer agent with respect to the shares until all conditions are met. I confirm my understanding and agreement that __________________________ (name of corporation) is selling its capital stock to me under the Securities Act of 1933 in reliance on the foregoing representation and agreement. Witness my signature this ___________________ (date) . _________________________ (Printed Name of Investor) _________________________ (Signature of Investor)