Pennsylvania SOI Supplement Form. This is a Pennsylvania form and can be use in Blue Sky Department Of State.
Tags: Pennsylvania SOI Supplement, SOIS, Pennsylvania Department Of State, Blue Sky
NOTE TO USERS: The following form sets forth the minimum informational requirement for soliciting indications of interest under the Pennsylvania Securities Act of 1972 (1972) when used in conjunction with Form SOI. You may include additional information if you think it necessary or desirable. Remember that any discussion in this document is subject to the anti-fraud provisions of the 1972 Act and must therefore be complete. You may not exaggerate the investment opportunity, minimize the risks of the enterprise or predict revenues, profits or payment of dividends (including financial projections and forecasts). The information in the Pennsylvania SOI Supplement is an integral part of the SOI Form and MUST accompany the SOI Form information at all times and under all circumstances. PENNSYLVANIA SOI SUPPLEMENT NAME OF COMPANY Check the appropriate response(s)) 1. The issuer's revenues during the last full fiscal year were: a. b. c. d. e. f. 2. Less than $10,000 . $10,000 or more but less than $50,000 . $50,000 or more but less than $250,000 . $250,000 or more but less than $1 million . $1 million or more . Issuer has been in existence for less than a full fiscal year The issuer had a profit or loss during its last full fiscal year of: a. PROFIT OF: Less than $10,000 . $10,000 or more but less than $50,000 . $50,000 or more but less than $250,000 . $250,000 or more . b. LOSS OF: Less than $10,000 . $10,000 or more but less than $50,000 $50,000 or more but less than $250,000 $250,000 or more . c. 3. . . . Issuer has been in existence for less than a full fiscal year . The average price per share of stock paid in cash by the issuer's current shareholders was: a. b. c. d. e. f. Less than $.01 . $.01 or more but less than $.05 $.05 or more but less than $.10 $.10 or more but less than $.25 $.25 or more but less than $1.00 $1.00 or more . . . . . 61 American LegalNet, Inc. www.USCourtForms.com 4. The issuer has engaged in the following transactions with its officers, directors, 10% shareholders or their affiliates or relatives: Issued securities in exchange for property or services Loaned money . Rented or purchased property . Purchased or sold goods or services . No such transactions have occurred . a. b. c. d. e. 5. During the last full fiscal year, the issuer's officers and directors received combined aggregate cash compensation of: a. b. c. d. e. 6. Less than $50,000 . $50,000 or more but less than $100,000 $100,000 or more but less than $250,000 $250,000 or more but less than $500,000 $500,000 or more . . . . . Does the issuer's liabilities currently exceed the fair market value of its assets? YES NO 8. . Are there any outstanding options or warrants held by current shareholders? YES NO 7. . . . Is the issuer now, or in the past two years was it, unable to meet its obligations as and when they become due in the usual course of business? YES NO . . 62 American LegalNet, Inc. www.USCourtForms.com