5/2003 STATE OF NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF CONSUMER AFFAIRS BUREAU OF SECURITIES BROKER-DEALER SUPPLEMENT INSTRUCTIONS: This application must be : RECEIPT filed by a person desiring to transact : business as a Broker-dealer. :FILING :DATE APPLICATIONS WILL BE ACCEPTED ONLY : WHEN ALL QUESTIONS ARE ANSWERED IN :EFF. FULL AND EACH OF THE REQUIRED : DOCUMENTS ACCOMPANY THE FORM : :CRD # : : : :FOR BUREAU USE ONLY On the New Jersey Bureau of Securities ("Bureau") received from the Central Registration Depository ("CRD") System information th at NAME with its principal office at seeks to apply for registration with the Bureau of Securities to transact securities business as a broker-dealer and submits in support thereof the following information: 1. The name and address of the person to contact with respect to this application: Name Telephone No. Address 2. The name and CRD numbers of the firms two registered principals required by NASD Rule 1021(e) or a copy of the NASDR, Inc. approved waiver. Name CRD # and Exams Passed American LegalNet, Inc. www.USCourtForms.com>>>> 23. Give nature and location of each business in which applicant has engaged during the preceding five years. Dates From To Name and Location Nature of Business 4. List the name and nature of the business for all parent companies of the broker-dealer: Parent Co. Name Nature of Business Date of Incorporation 5. List the names, CRD numbers (or SSN) and addresses of the 10% or more shareholders of any parent companies. If multiple holding companies exist, list the same for each parent company. If parent company is a public entity, please state so. Name CRD # / SSN Address THE FOLLOWING DOCUMENTS MUST ACCOMPANY THE APPLICATION AS A PART THEREOF : American LegalNet, Inc. www.USCourtForms.com>>>> 31. The completed New Jersey Broker-Dealer Supplement Form. 2. An executed copy of the attached statement that the applicant has read and understands the Uniform Securities Law (1997). 3. An executed copy of the attached statement that the applicant has met the minimum net capit al requirements as specified by Section 15 of the Securities Exchange Act of 1934. 4. An executed copy of the attached statement that the applicant has not offered or sold securities within or from New Jersey at any time. OR a list of the names and addresses of New Jersey residents or accounts to whom securities have been offered or sold. The list shall include the following for each such resident or account: i. the securities offered or sold; ii. number of shares or units; iii. dollar amount of each transaction; iv. date of each transaction; and v. the name of the representative or person who effected the transaction or offered the securities. 5. An executed copy of the attached statement granting the Bureau authorization to examine any filings the applicant has made with the NASD or New York Stock Exchange, Amer ican Stock Exchange, or another major stock exchange. 6. The latest certified financial statement and balance sheet prepared within 60 days of application date signed by a principal and notarized. FINANCIAL STATEMENTS: A certified (audited) financial statement which contains the opinion letter of the independent accountant is required. If the audited financial statement was prepared as of a date more than 60 days prior to the filing of the application, an additional financial statement prepared within the 60-day period must be filed. This supplementary statement may be unaudited provided that it is signed by an officer and notarized. Part II or Part II A of the applicants latest quarterly FOCUS report may be substituted for the supplementary statement, but it must also be signed by an officer and notarized. Firms newly approved by the NASD must submit a copy of their engagement letter with a notarized una udited financial statement in lieu of an audited financial statement. AMENDMENTS Any changes to information contained on this supplement should be filed by submitting this supplement including only the changed information or by letter within 30 days of said change. All other changes should be made directly with the CRD. American LegalNet, Inc. www.USCourtForms.com>>>> 4 STATE OF NEW JERSEY BROKER/DEALER APPLICATION CERTIFICATION The undersigned being the individual applicant of an officer, director, general partner of the applicant corporation or partnership, of full age, deposes and says that: (1) he has read and understands the provisions of section 49:3-54 of the Uniform Securities Law (1997); (2) he has read all of the statements contained on this form and they are true and correct; and (3 ) he understands that any false or misleading statement constitutes a violation of the Uniform Securities Law (1997). (L.1997, C.276) I certify that the foregoing statements made by me are true, I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. Date: (Signature) _ (Title) American LegalNet, Inc. www.USCourtForms.com>>>> 5 STATE OF NEW JERSEY BROKER/DEALER APPLICATION CERTIFICATION OF NO SALE The undersigned ,a duly authorized officer of on behalf of the Broker/Dealer, certify that has not transacted business as a Broker/Dealer in the State of New Jersey. agrees to comply with the New Jersey Securities Act and to refrain from transacting business as a Broker/Dealer in the State of New Jersey until such time as both and its agent(s) thereof are duly registered with the New Jersey Bureau of Securities. I certify that the foregoing statements made by me are true, I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. Dated: (Signature) (Title) American LegalNet, Inc. www.USCourtForms.com>>>> 6 STATE OF NEW JERSEY BROKER/DEALER APPLICATION MINIMUM NET CAPITAL CERTIFICATION The undersigned ,a duly authorized officer of on behalf of the Broker/Dealer, certify that is in compliance with the minimum required amount of net capital as specified by the Securities Exchange Act of 1934, Rule 15c3-1. I certify that the foregoing statements made by me are true, I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. Dated: (Signature) (Title) American LegalNet, Inc. www.USCourtForms.com>>>> 7 STATE OF NEW JERSE