IDAHO DEPARTMENT OF FINANCE Securities Bureau 700 West State Street, 2nd Floor P.O. Box 83720 Boise, ID 83720-0031 Website: idahofinance.com Fax: 208/332-8099 208/332-8004 GUIDELINES FOR COMPLETING THE SECURITIES COMPLAINT FORM Before filling out the attached complaint form, please take the time to read these guidelines; they will help you understand our functions, and we will be better able to understand and act on your complaint. WHAT WE CAN DO: We investigate complaints against persons, business entities, and corporations accused of violating the licensing or anti-fraud provisions of laws administered by the Department. We are empowered to bring administrative or civil actions to stop these violations, and, in appropriate cases, to refer matters to the Prosecuting Attorneys' offices for criminal prosecution. WHAT WE CANNOT DO: We cannot act as a court of law, so we cannot order that monies be refunded, contracts be canceled, damages be awarded, etc. If you have this type of problem, you should consult an attorney. We cannot give legal advice or act as your attorney. HOW YOU CAN HELP US: The purpose of this complaint form is to provide this Department with enough information to allow us to determine if an investigation into your allegations is warranted. Thus, it is important for you to furnish as much detailed information as possible. Documentary evidence is especially important, therefore, you should photocopy all documents such as contracts, agreements, certificates, notes, trust deeds, correspondence, legible copies of the front and back of checks involved, escrow documents, advertising, etc., and attach them to the written complaint. (Please do not send originals; we cannot be responsible for their safekeeping.) Type or print clearly in ink. If you have any questions concerning this form, you may contact the Securities Bureau at 208/332-8004. Upon completion of all sections, please mail the form along with your supporting documents to: Idaho Department of Finance Securities Bureau 700 West State Street, 2nd Floor P.O. Box 83720 Boise, ID 83720-0031 Enclosure 1 American LegalNet, Inc. www.USCourtForms.com COMPLAINT FORM INFORMATION ABOUT YOU A. Last Name First Middle Today's Date Home Address ( City ) State Zip Telephone Number State Zip ( ) Telephone Number Age Marital Status Business Address City Trade or Occupation Are you willing to be interviewed by an investigator from this office? Yes No Are you willing to be a witness if formal proceedings are commenced by the Idaho Department of Finance? Yes No SUBJECT OF COMPLAINT B. Company Name Address Telephone No. List persons who were involved in selling you the investment (please use separate pages to set forth any other available information about these persons.) Last Name First Last Name Address First Position Telephone No. City Address Middle State Zip Middle Position Telephone No. City State Zip 2 American LegalNet, Inc. www.USCourtForms.com Please explain in detail your previous investment experience (type, date, amount) with either the company or the salesperson who contacted you. Additionally, describe any personal relationships/dealings with the company or the salesperson. 3 American LegalNet, Inc. www.USCourtForms.com INFORMATION ABOUT INVESTMENT C. What did you purchase or invest in? (Examples: common stock, debenture, limited partnership interest, investment contract, fractional interests in an oil and gas lease). Include the date of purchase, the number of units or shares purchased and the amount paid. Date of Purchase Security No. of Shares Unit Price Total Price Date of Purchase Security No. of Shares Unit Price Total Price Date of Purchase Security No. of Shares Unit Price Total Price How was the amount paid: (lump sum, installments, other / check, cash, other) Who received the payment from you? Did you pay by mail? To whom did you make your checks payable? (Please provide a copy of both sides of the check if possible) D. In a brief statement, tell us the full story beginning with the date of your first contact to present. Keep dates of events in sequence and include misrepresentations. Include full names of individuals, including all witnesses present during the transaction(s). Be factual. Try to answer the questions "who", ''what'', ''where'' and ''when.'' Attach extra sheets if more space is needed. 4 American LegalNet, Inc. www.USCourtForms.com E. How did you learn of the investment? (Check more than one if necessary and enclose copies of pamphlets or advertisements if possible.) Personal visit When? Where? Whom? Who else was present? Telephone call Date? From whom? At what address/location was the call received? Advertising pamphlet/sales letter Sent to you at what address/location? Copy of pamphlet enclosed? Copy of envelope attached? 5 American LegalNet, Inc. www.USCourtForms.com Newspaper Name of paper? Date? Copy of advertisement enclosed? Radio Name of station? Date Television Name of station? Date? Group Sales Presentation Date of presentation? Where? Others present? Other (Please Specify) F. List others who were present when the offers or sales were made to you. Name Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name G. Address Address Telephone Relationship to Complainant Did you sign any type of contract? If so, please enclose a copy. Where was it signed (city/county)? Who else was present? Were your securities delivered? Where are your securities held? If your securities have been delivered to you by mail, please attach a copy of the cover letter attached to your securities. 6 American LegalNet, Inc. www.USCourtForms.com H. Who else do you know that invested with the company, corporation, or association? Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant Name Address Telephone Relationship to Complainant I. Yes Have you complained to subject or seller? If yes, what offer of adjustment or explanation was made? No J. Have you notified or filed a complaint with any of the following agencies? U.S. Securities and Exchange Commission Idaho Attorney General Local Police Dept. Other Federal Agency or Office Better Business Bureau County Prosecuting Attorney K. Sheriff's Office Local Newspaper Have you or any other victims filed a lawsuit in any court? Yes No If yes, please provide the name of the case/county/case number and provide a copy of the court documents. 7 American LegalNet, Inc. www.USCourtForms.com L. What would you consider to be a satisfactory solution? I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF IDAHO THAT THE FOREGOING STATEMENTS AND PHOTOCOPIES OF ATTACHED DOCUMENTS ARE TRUE AND CORRECT. Signature (Please sign in ink) Date 8 American LegalNet, Inc. www.USCourtForms.com