S.A. 8 (7/1/91) COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION DIVISION OF SECURITIES AND RETAIL FRANCHISING REGISTRATION BY QUALIFICATION 13.1-510 1. Name and address of issuer: 2. Name and address of registrant: 3. Name, address and telephone number of correspondent to whom notice and c ommunications regarding the application may be sent: Telephone: 4. Description of SecuritiesOffering Price Number Amount -------------------------------------------------- ------------------- -------------------------- -------------------------- Total: _________________ 5. Fee (1/10 of 1% of the Amount in 4 above; minimum fee $250; maximum fee $500): $ The registrant, after making reasonable inquiry, believes that the facts herein stated are true. Registrant By Date Title American LegalNet, Inc. www.USCourtForms.com>>>> 2S.A. 8 INSTRUCTIONS 1. A registration statement shall become effective when the Commission so o rders. 2. The following statement must appear in the prospectus: THE VIRGINIA STATE CORPORATION COMMISSION DOES NOT PASS UPON THE ADEQUACY OR ACCURACY OF THIS PROSPECTUS OR UPON THE MERITS OF THIS OFFERING AND THE COMMISSION EXPRESSES NO OPINION AS TO THE QUALITY OF THIS SECURITY. 3. The information required by 13.1-510 (b) (1) - (15) may be pr ovided by: - cross reference sheet(s) * or - exhibit booklet * You should underscore the corresponding information in the prospectus wi th an appropriate cross-reference made in the margin of the prospectus indicating the code section referenced. Any information not found in the prospectus should be attached to the cr oss reference sheet. Areas not applicable should be footnoted with an explanation. American LegalNet, Inc. www.USCourtForms.com