SECURITIES AND BUSINESS REGULATION 2 Martin Luther King, Jr. Drive, S.E. Ste 802, West Tower Atlanta, Georgia 30334 (404) 656-3920 http://www.sos.state.ga.us/securities/ ROBERT D. TERRY Assistant Commissioner of Securities KAREN HANDEL Commissioner of Securities DESIGNATED DEALER NOTIFICATION Georgia Securities Act of 1973, as amended O.C.G.A. §10-5-3(p) and Rule 590-4-2-.16 1. NAME & MAILING ADDRESS OF DEALER 2. DEALER'S CRD NUMBER 3. GA DEALER NUMBER 4. NAME OF DEALER'S COMPLIANCE OFFICER 5. TELEPHONE NUMBER 6. THE DEALER IS FILING DESIGNATED DEALER STATUS DUE TO (check one) : (a) INCOME LEVEL TEST - O.C.G.A. §10-5-2(a) (9) (A) [ ] (b) MARKET MAKER TEST - O.C.G.A. §10-5-2(a) (9) (B) [ ] 7. DATE FIRM BECAME A DESIGNATED DEALER: 8. DATE FIRM CEASED TO BE A DESIGNATED DEALER: 9. CHECK NUMBER OF $20.00 FILING FEE CHECK #: 10. EXECUTION AND ACKNOWLEDGEMENTS. The undersigned, for the purpose of complying with the Georgia Securities Act of 1973, as amended, certifies that the dealer named herein is in compliance with said Act and has determined that it is required to notify the Commissioner of Securities of the State of Georgia, that it has become a designated dealer as that term is defined in O.C.G.A. §10-5-2(a) (9). By submitting this notification in the form of a Georgia only amendment to Form BD, the designated dealer and the applicant acknowledge that its salesmen are in compliance with the training requirements of O.C.G.A. §10-5-3(d) and the Rules and Regulations promulgated thereunder and that such designated salesmen have received or have begun and will complete, prior to offering and selling designated securities, training regarding the requirements relating to designated dealers, designated salesmen and designated securities including, but not limited to, the definitions of accredited investor, designated security, blank check offering, designated dealer and established customer [See O.C.G.A. §10-5-2(a)]; the required contents of trade confirmations [See O.C.G.A. §10-5-3(p)]; suitability of customer accounts [See O.C.G.A. §10-5-12(m) (2)]; required risk disclosure document [See O.C.G.A. §10-5-12(m) (3)]; customer right of rescission [See O.C.G.A. §10-5-12(m) (4)]; required account statement disclosure [See O.C.G.A. §10-5-12(m) (5)]; compensation limits [See O.C.G.A. §10-5-12(n)]; representations as to market price [See O.C.G.A. §10-5-12(o)]; the anti-fraud provisions of O.C.G.A. §10-5-12; the requirement for designated securities to be listed on an approved quotation system [See O.C.G.A. §10-5-12(p)]; civil liability [See O.C.G.A. §10-5-14(h)]; and the criminal penalties for willful violations of the Act [See O.C.G.A. §10-5-24]. The undersigned represents that the information and statements contained herein are true and complete. 11. NAME AND TITLE OF AUTHORIZED OFFICIAL 12. SIGNATURE FILING DATE: EXAMINER: DATE: FOR OFFICE USE ONLY CODE: FEE: $ DOCKET #: COMPLETED: FORM DD Rev. 1/2007 American LegalNet, Inc. www.FormsWorkflow.com