FIS 0554 (5/04) Office of Financial and Insurance Services replaces C&S 8424 Uniform Application to Register Securities Form U-1 (SCOR) Application to pursuant to Section of the for the State of . 1. Name and address of Issuer and principal office in this State: Name Address City State Zip Code 2. Name, address and telephone number of correspondent to whom notices and communications regarding this application may be sent: Name Telephone ( Address City State ) Zip Code 3. Name and address of applicant: Name Address City State Zip Code 4. Registration or acceptance for filing is sought for the following described securities in the amounts indicated: Offering Price or Proposed Offering Price Total Offering Number of Shares or Units Amount Offering in This State Number of Shares or Units Amount Description of Securities $ $ Totals Indicate the maximum commission to be charged: $ % $ 5. Amount of filing and examination fees which are enclosed: Filing Fees Examination Fees $ $ 6. List the states in which it is proposed to offer the securities for sale to the public. List the states, if any, in which the securities are eligible for sale to the public. List the states, if any, which have refused, by order or otherwise, to authorize sale of the securities to the public, or have revoked or suspended the right to sell the securities, or in which an application has been withdrawn. Michigan Department of Labor & Economic Growth The Department of Labor & Economic Growth will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency. Visit OFIS online at: www.michigan.gov/ofis Phone OFIS toll-free at: 1-877-999-6442 American LegalNet, Inc. www.FormsWorkflow.com 7. Submitted herewith as a part of this application are the following documents (documents on file may be incorporated by reference): Underwriting Agreement, Agreement among Underwriters, and Selected Dealers Agreement. Indenture. Issuer's charter or articles of incorporation as amended to date. Issuer's bylaws as amended to date. Signed copy of opinion of counsel. Specimen (type of security) Consent to service of process accompanied by appropriate corporate resolution. If an earning computation or similar requirement is required to be met in this state, attach a separate sheet as an exhibit showing compliance. One copy of all advertising matter to be used in connection with the offering. Others (List each): 8. The applicant hereby applies for registration for acceptance for filing of the above described securities under the law cited above and in consideration thereof agrees so long as the registration remains in effect that it will: (a) Advise the above named state authority of any change prior to registration in this state in any of the information contained herein or in any of the documents submitted with or as a part of this application. (b) File with the above named state authority (i) any amendments other than delaying amendments to the registration statement, designating the changed, revised or added material or information by underlining the same; and (ii) the final prospectus, or any further amendments or supplements thereto. (c) Notify the above named state authority within two business days (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 currently being offered to the public. (d) Notify the above named state authority of (i) any request by the issuer or applicant to any other state or regulatory authority for permission to withdraw any application to register the securities described herein; and (ii) a list of all states in which applications have been filed where the issuer or applicant has received notice from the state authority that the application does not comply with state requirements and cannot or does not intend to comply with such requirements. (e) Furnish promptly all such additional information and documents in respect to the issuer or the securities covered by this application as may be requested by the above named state authority prior to registration or acceptance for filing. American LegalNet, Inc. www.FormsWorkflow.com Date: (Name of Applicant) By (Name and Title) STATE OF COUNTY OF The undersigned, } being first duly sworn, deposes and says: of such applicant and is fully authorized to execute and file such That he has executed the foregoing application for and on behalf of the applicant named therein; that he is application; that he is familiar with such application; and that to the best of his knowledge, information and belief the statements made in such application are true and the documents submitted therewith are true copies of the originals thereof. (Name) Subscribed and sworn to before me this day of NOTARY PUBLIC in and for the County of State of My Commission Expires: (Notarial Seal) , American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS TO FORM U-2 UNIFORM CONSENT TO SERVICE OF PROCESS 1. The name of the issuer is to be inserted in the blank space on line 1 Uniform Form U-2 ("Form"). 2. The type of person executing the Form is to be described by striking out the inapplicable nomenclature in lines 2-4 and, if appropriate, by inserting a description of the person in the blank space provided on line 2 of the Form. 3. The name of the jurisdiction under which the issuer was formed or is to be formed is to be inserted in the blank spaces on line 3 of Form. 4. The person to whom a copy of any notice, process of pleading which is served pursuant to the Consent to Service of Process is to be inserted in the appropriate blank spaces at the end of page 1 of the Form. 5. An "X" is to be placed in the space before the names of all States which the person executing this Form lawfully is appointing the officer of each State so designated on the Form as its attorney in the State for receipt of service of process. 6. A manually signed Form must be filed with each State requiring a Consent to Service of Process on Form U-2 at the office so designated by the laws or regulations of that State and must be