STATE OF ARKANSAS SECURITIES DEPARTMENT HERITAGE WEST BUILDING, SUITE 300 201 EAST MARKHAM STREET LITTLE ROCK, AR 72201 TELEPHONE: 501.324.9260 FAX: 501.324.9268 INTERNET: www.state.ar.us/arsec CI Form 007 DEPOSIT IN LIEU OF SURETY BOND UNDER THE SALE OF CHECKS ACT OF ARKANSAS THIS CONTRACT AND AGREEMENT, entered into this _________ day of ________________, _________, between ___________________________________, a _____________________________________________________________________________ (Trust, Corporation, Individual, Joint Stock Association, Partnership or Unincorporated Association) organized under the laws of the State of _____________________________________ and doing business in the State of Arkansas (hereinafter called the “Licensee”), and the State Securities Commissioner of the State of Arkansas (hereinafter called the (“Commissioner”). WITNESSETH WHEREAS, the said Licensee is subject to the Act regulating the sale or issuance of checks, drafts, money orders or other written instruments for the transmission or payment of money or credit which Act entitled the “Sale of Checks Act” of Arkansas, and WHEREAS, said Act provides for the deposit of securities, with a market value equal to the amount of a required surety bond in lieu thereof, and CI Form 007 Page 1 of 4 Effective Date: December 1, 2003 American LegalNet, Inc. www.USCourtForms.com WHEREAS, the Commissioner may provide for custody of such securities by any qualified trust company or bank located in the State of Arkansas or by any Federal Reserve Bank (hereinafter called the “Custodian”), and the Commissioner hereby designates ____________________________________________ having its principal place of business in _______________________________________ as Custodian, and WHEREAS, the Commissioner has agreed to accept a deposit of securities in lieu of a surety bond and has agreed that _______________________________________________ is qualified to act as Custodian. NOW, THEREFORE, in consideration of these premises, the Liensee deposited with the Custodian the following securities: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ and it is agreed between the parties hereto: 1. Subject to the provisions herein contained, these securities are deposited to secure payment to any creditor or claimant of the Licensee for any liability incurred on any checks as defined in the aforesaid Act. CI Form 007 Page 2 of 4 Effective Date: December 1, 2003 American LegalNet, Inc. www.USCourtForms.com 2. The securities deposited may be exchanged from time to time for other securities, receivable as foresaid, that qualify under the provision of the Act relating to this deposit providing the market value of all securities deposited hereunder is at least equal to the amount of a required surety bond in lieu thereof. 3. All interest or dividends on all securities deposited shall be payable to or in accordance with the instructions of the Licensee, unless and until the Commissioner gives contrary notice to the Custodian, which notice shall be in writing an supported by the certified copy of an order of a court of a competent jurisdiction which order by its terms prohibits receipt by said Licensee of such interest or dividends because of the insolvency of said Licensee. 4. The Licensee agrees that the Commissioner shall have the right from time to time to order the Custodian to sell, transfer, or otherwise dispose of any securities and to convert the same into cash and to pay and deliver any securities and cash to said Commissioner, all such instruction, however, from the Commissioner is to be in writing and supported by a certified copy of an order of a court of competent jurisdiction. 5. If the Licensee will faithfully conform to and abide by the provisions of the aforesaid Act and will honestly and faithfully apply all funds received and perform all obligations and undertakings for exchange issued and sold under said Act and will pay to the State and to any person entitled thereto all money that becomes due and owing to the State or to such person under the provisions of said Act because of any checks or exchanges CI Form 007 Page 3 of 4 Effective Date: December 1, 2003 American LegalNet, Inc. www.USCourtForms.com issued or sold in the State of Arkansas by the aforesaid principal under and by virtue of the provisions of said Act, then the Commissioner shall have no further right in or claim to the securities deposited. 6. The Licensee agrees to pay all charges by the Custodian, if any, for its services in connection with the agreement. 7. This agreement is executed in triplicate, one counterpart to be kept by each of the parties hereto and one counterpart to be kept by the Custodian. Signed, sealed and delivered in triplicate this _______ day of __________________, _______. BY: _________________________________________ BY: _________________________________________ STATE SECURITIES COMMISSIONER _________________________________________, Custodian, hereby acknowledges receipt of the securities described in the foregoing agreement and covenants and agrees that the same will be held by it for the purposes and subject to the terms and conditions of said agreement, but reserves the right to resign as Custodian by giving thirty (30) days written notice to the signers of the agreement. ______________________________________ DATE: ____________________ CI Form 007 BY: ______________________________________ TRUST OFFICER Page 4 of 4 Effective Date: December 1, 2003 American LegalNet, Inc. www.USCourtForms.com