APPOINTMENT OF THE SECRETARY OF STATE AS AGENT OF SERVICE THE STATE OF ____________________ } [ KNOW ALL MEN BY THESE PRESENTS COUNTY OF _______________________} That________________________________________________________________, a telephone solicitation seller in the state of ____________________, does hereby irrevocably designate, constitute and appoint the Secretary of State of the State of Texas and any successors in office, the authorized agent and attorney-in-fact of the above-named seller for the purpose of accepting service for it and being served for it with citation in any noncriminal suit, action, or proceeding against said seller or the seller's successor, executor, or administrator that may arise under Tex. Bus. & Com. Code, Section 302.001 et seq. _________________________________ (Signature & Title) _________________________________ (Typed or Printed Name) _________________________________ (Signature & Title) _________________________________ (Typed or Printed Name) State of ______________________ County of ____________________ _____________________________________ (Signature & Title) _____________________________________ (Typed or Printed Name) ____________________________________ (Signature & Title) _____________________________________ (Typed or Printed Name) Sworn to and subscribed before me on the _______ day of ______________________, _______. _____________________________________ Notary Public Signature (seal) _____________________________________ (Printed Name) My commission expires __________________. Form #3406 American LegalNet, Inc. www.FormsWorkFlow.com