VERMONT SECURITIES DIVISION CONSENT TO SERVICE OF PROCESS KNOW ALL MEN BY THESE PRESENTSthat the undersigned _________________________________ ___________________________(a corporation) (a partnership), (a______________) organized under the laws of __________________, or (an individual)[strike out inapplicable nomenclature] for purposes of complying with the laws of the State of Vermont, hereby irrevocably appoints the Commissioner of Banking, Insurance, Securities and Health Care Administration (“Commissioner”) for the State of Vermont and his/her successors in office, its attorney in Vermont upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of, or in connection with, the sale of securities or out of violation of the aforesaid laws of the State of Vermont; and the undersigned does hereby consent that any such action or proceeding against it may be commenced in an administrative forum or in any court of competent jurisdiction, and proper venue within the State of Vermont by service of process upon the Commissioner with the same effect as if the undersigned was organized or created under the laws of the State of Vermont and have` been served lawfully with the process in the State of Vermont. It is requested that a copy of any notice, process or pleading served hereunder be mailed to:_______________________________________________________________________ . Dated this_____ day of _____________________, _____ . By: _________________________________________________ _________________________________________________ _________________________________________________ Title CORPORATE/LLC ACKNOWLEDGMENT State or Province of __________________} County of _______________________________} ss. On this ___________ day of ____________________, _____, before me personally appeared _____________________________________known personally to me to be the ______________________ (title) of the above-named (corporation) (LLC) and acknowledged the s/he, as an (officer) (LLC) being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the (corporation) (LLC) by him/herself as an (officer) (member). IN WITNESS WHEREOF, I have hereunto set my hand and official seal. __________________________________________________ Notary Public/Commissioner of Oaths My Commission Expires: _____________________________ (SEAL) INDIVIDUAL, PARTNERSHIP, OR LLP ACKNOWLEDGMENT State or Province of _____________________} County of _____________________________} ss. On this ________ day of _________________________, _______, before me personally appeared _______________________________ known personally to me to be the same person(s) whose name(s) is (are) signed to the foregoing instrument, and acknowledged the execution thereof for the uses and purposes therein set forth. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. (SEAL) __________________________________________________ Notary Public/Commissioner of Oaths My Commission Expires:_____________________________ Revised 7/17/00 American LegalNet, Inc. www.USCourtForms.com