ARIZONA CORPORATION COMMISSION SECURITIES DIVISION AFFIDAVIT REGARDING OFFERS OF ULOR SECURITIES STATE OF ) _______________________ ) ss County of ________________________ ) I, ________________________________________, being first duly sworn on oath depose and say: I am now a citizen of the United States of America, over the age of twen ty-one and competent to be a witness. I am a bona fide officer or director of ______________________________ ___________ (the issuer). I will provide each person to whom I offer securities with the form Consumers Guide to Smal l Business Investments, and I will obtain a dated receipt from each su ch investor. I understand that failure to comply with this requirement is grounds for revocation or suspension of my license. I understand that the license for which I am applying only authorizes me to offer and sell securities on behalf of ______________________________________________ (issuer s name) and must be done pursuant to the registration statement on file with the Arizona Corporation Commission, Securities Division. Please check one of the boxes below: I will not be receiving sales related compensation for the sale of the U LOR securities. I will be receiving sales related compensation for the sale of the ULOR securities. ____________________________________________________ SUBSCRIBED and SWORN to before me this __________day of ______________________, 2004. ____________________________________________________ Notary Public in and for the state of ____________residing at ____________________________________________________ 5/04 American LegalNet, Inc. www.USCourtForms.com