State of California Secretary of State PROOF OF ESTABLISHMENT OF ESCROW ACCOUNT SELLER OF TRAVEL DISCOUNT PROGRAMS (Business and Professions Code section 17550 et seq.) Instructions: 1. Form is to be executed by a bank officer. 2. Complete and mail to: Secretary of State, Special Filings Unit P.O. Box 942870 Sacramento, CA 94277-2870 (916) 653-3984 (Office Use Only) For the purpose of complying with Business and Professions Code section 17550.27 and Civil Code section 1812.101, the organization listed below is a seller of travel discount programs which has established an escrow account in the amount of fifty thousand dollars ($50,000) for the purpose of providing refunds to members. (Name of Organization) (Street Address of Organization) (Name of Principal Officer of Organization) (Title) This form serves as written notice to the Secretary of State of the State of California that an escrow account for the above-named organization has been established pursuant to Business and Professions Code section 17550.27 and Civil Code section 1812.101. The bank or financial institution listed below is a federally insured bank or federally insured financial institution, independent of the above-named organization, authorized to transact business in California. Executed at on (Name of FDIC-insured Bank or Financial Institution) (Street Address of FDIC-insured Bank or Financial Institution) (City, State, Zip) (Typed or Printed Name of Authorized Officer of FDIC-insured Bank or Financial Institution) (Signature of Authorized Officer of FDIC-insured Bank or Financial Institution) SFSB-263A Rev 04/2015 American LegalNet, Inc. www.FormsWorkFlow.com