ILLINOIS SECURITIES DEPARTMENT Lincoln Tower, Suite 200 520 South Second Street Springfield, Illinois 62701 SOLICITATION OF INTEREST FORM _________________________________________________________ NAME OF COMPANY Street Address of Principal Office: _________________________________________ Company Telephone Number: _____________________________________________ Date of Incorporation/Formation: __________________________________________ Amount of the Proposed Offering: __________________________________________ Name of Chief Executive Officer: ___________________________________________ THIS IS A SOLICITATION OF INTEREST ONLY. NO MONEY OR OTHER CONSIDERATION IS BEING SOLICITED AND NONE WILL BE ACCEPTED; NO SALES OF THE SECURITIES WILL BE MADE OR COMMITMENT TO PURCHASE ACCEPTED UNTIL THE DELIVERY OF A FINAL OFFERING STATEMENT THAT INCLUDES COMPLETE INFORMATION ABOUT THE ISSUER AND THE OFFERING; AN INDICATION OF INTEREST MADE BY A PROSPECTIVE INVESTOR INVOLVES NO OBLIGATION OR COMMITMENT OF ANY KIND; THIS SOLICITATION OF INTEREST IS BEING MADE PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE FEDERAL AND STATE SECURITIES LAWS. NO SALE MAY BE MADE UNTIL THE OFFERING STATEMENT IS QUALIFIED BY THE SEC AND IS REGISTERED IN THIS STATE; AND NEITHER THE FEDERAL NOR THE STATE AUTHORITIES HAVE CONFIRMED THE ACCURACY OR DETERMINED THE ADEQUACY OF THIS DOCUMENT OR ANY OTHER 2002 © American LegalNet, Inc. DOCUMENT PRESENTED TO YOU IN CONNECTION WITH THIS SOLICITATION OF INTEREST. This Company: ( ) Has never conducted business operations. ( ) Is in the development stage. ( ) Is currently conducting operations. ( ) Has shown a profit for the last fiscal year. ( ) Other (specify) BUSINESS 1. Describe in general what business the company does or proposes to do, including what products or goods are or will be produced or services that are or will be rendered. 2. Describe in general how these products or services are to be produced or rendered and how and when the company intends to carry out its activities. OFFERING PROCEEDS 3. Describe in general how the company intends to use the proceeds of the proposed offering. KEY PERSONNEL OF THE COMPANY 4. Provide the following information for all officers and directors or persons occupying similar positions. • • • • • • Name Title Office Address (including street address and city, state and zip code) Telephone Number Employment History (employers, titles, and dates of positions held during the past five years) Education (degrees, schools and dates) 2002 © American LegalNet, Inc.