SECURITIES AND BUSINESS REGULATION 237 Coliseum Drive Macon, Georgia 31217-3858 (478) 207-2440 http://www.sos.ga.gov/securities/ BRIAN P. KEMP Commissioner of Securities CONSENT TO SERVICE OF PROCESS KNOW ALL PERSONS BY THESE PRESENTS: That the undersigned, Circle one: A. A corporation organized under the laws of the State of: (Corporate Resolution or Form U2A is required) B. A limited liability company organized under the laws of the State of: C. A limited partnership organized under the laws of the State of: D. An individual E. Other for the purpose of complying with the laws of the State of Georgia relating to either the registration or sale of securities, hereby irrevocably appoints the Commissioner of Securities, and the successors in such office, its attorney in the State of Georgia upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of or in connection with the sale of securities or out of violation of the aforesaid laws of said State. The undersigned does hereby consent that any such action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within said State by service of process upon said officer with the same effect as if the undersigned was organized or created under the laws of said State and had lawfully been served with process in said State. It is requested that a copy of any notice, process or pleading served hereunder be mailed to: Name: Address: City/State/Zip: This day of , 20 Applicant: By: (SEAL) Print Name and Title: Attest (Authorized Signature): Print Name and Title: Form 6 Rev. 2/2011 American LegalNet, Inc. www.FormsWorkFlow.com