NOTE TO USERS: The following form sets forth the minimum informational requirement for soliciting indications of interest under federal and state securities laws. You may include additional information if you think it necessary or desirable. Remember that any discussion in this document is subject to the antifraud provisions of the federal and state securities laws 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). You may alter the graphic presentation of the form in any way as long as the minimum information is clearly presented. 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. SOLICITATION OF INTEREST FORM NAME OF COMPANY Street Address of Principal Office: Company Telephone Number: Date of Organization: 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 CIRCULAR OR PROSPECTUS 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 OFFER IS BEING MADE PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE FEDERAL AND STATE SECURITIES LAWS. NO SALE MAY BE MADE UNTIL THE OFFERING IS QUALIFIED BY THE SEC AND IS REGISTERED IN THIS STATE1 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) 1 The language "IS QUALIFIED BY THE SEC AND" is not applicable if the offering is made under Section 3(a)(11) of the federal Securities Act of 1933. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 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, directors or persons occupying similar positions: Name, Title, Office Street Address, Telephone Number, Employment History (Employers, titles and dates of positions held during the past five years), and Education (degrees, schools and dates). Please be advised that all representations in this application are subject to the penalties of 18 Pa. C.S. §4904 (relating to unsworn falsification to authorities). Furthermore, your application will be considered a document filed with the Department of Banking and Securities for purposes of Section 407 of the 1972 Act, 70 P.S. §1-407. IN WITNESS WHEREOF, this report has been executed on (insert date) (Name of Issuer) By: Title: Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com