State of Nevada Secretary of State Securities Division Application For Licensing of a Branch Office Nevada Form 360-2 rev 11/2001) To: Office of the Secretary of State Securities Division Ms. Terry Sanchez, Licensing Examiner 555 E. Washington Avenue, Suite 5200 Las Vegas, Nevada 891 01 (702) 486-2440 NOTE: Please submit a separate form for each branch office. Attach proof of certificate to do business from the Nevada Secretary of State, if the broker-dealer is a foreign corporation, and include filing fee of $100.00. Name of Broker-Dealer: Firm's CRD Number: Hereby requests licensing of the following office located in Nevada at: Address: Number, Street, City, State and Zip must be included. Do Not Use a P.O. Box Number 90.370 ''Branch Office'' means any place of business in [Nevada] from which one or more sales representatives transact business. Telephone Number: THIS OFFICE IS A(N): (Check One) NASD OSJ Branch NASD NON-OSJ Branch NEVADA Branch Only BRANCH OFFICE INFORMATION Name of Registered Representative located in this branch CRD NO. SOCIAL SECURITY NO. Name of Registered Supervisor of Office CRD NO. SOCIAL SECURITY NO Address of the Office of Supervisory Jurisdiction to which branch reports The registrant submitting this form and its attachments and the person executing it represent hereby that it and all materials filed in connection with it contain a true, correct and complete statement of all required information. Dated the day of I (Typed Name of Undersigned) (Signature of Executive Officer, Partner, Sole Proprietor) American LegalNet, Inc. www.FormsWorkflow.com