ALTERNATIVE DISTRIBUTION INFORMATION Sample Clauses

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distributions to a party other than the registered owner, complete the information below. Name of Firm (Bank or Brokerage): ______________________________________________ Account Name: ______________________________________________________________ Account Number: ____________________________________________________________ Address: _______________________________ City, State ZIP: _______________________

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distributions to a party other than the registered owner, complete the information below. YOU MUST COMPLETE THIS ITEM IF THIS IS AN IRA INVESTMENT. Name of Firm (Bank or Brokerage): ___________________________________________________________________ Account Name: _____________________________________ Account #: ______________________________ Address: __________________________________________________________________________

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distributions to a party other than the registered owner, complete the information below. YOU MUST COMPLETE THIS ITEM IF THIS IS AN IRA INVESTMENT. Account Name: Account #: Address:

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distributions to a party other than the registered owner, complete the information below. YOU MUST COMPLETE THIS ITEM IF Account Name: Account #: Address:

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distribution to a party other than the registered owner, complete the information below. YOU MUST COMPLETE THIS SECTION IF THIS IS AN ▇▇▇ INVESTMENT. Name of Firm (Bank, Brokerage, Custodian): Account Name: Account Number: Representative Name: Representative Phone Number: Address: City, State, Zip: _________________________________ Name (Please Print) _________________________________ Name of Additional Purchaser _________________________________ Residence: Number and Street _________________________________ Address of Additional Purchaser _________________________________ City, State and Zip Code _________________________________ City, State and Zip Code _________________________________ Social Security Number _________________________________ Social Security Number _________________________________ Telephone Number _________________________________ Telephone Number _________________________________ Fax Number (if available) ________________________________ Fax Number (if available) _________________________________ E-Mail (if available) ________________________________ E-Mail (if available) __________________________________ (Signature) ________________________________ (Signature of Additional Purchaser) ACCEPTED this ___ day of _________ 2008, on behalf of the Company. By: _________________________________ Name: Title: Date of Incorporation or Organization: State of Principal Office: Federal Taxpayer Identification Number: ____________________________________________ Office Address ____________________________________________ City, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) By: /s/ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Name: ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Title: CFO [seal] Attest: _________________________________ (If Entity is a Corporation) _________________________________ _________________________________ Address ACCEPTED this 17 day of July 2008, on behalf of the Company. By: /s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Name: ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Title: Chief Executive Officer Instructions: Check all boxes below which correctly describe you. o You are (i) a bank, as defined in Section 3(a)(2) of the Securities Act of 1933, as amended (the “Securities Act”), (ii) a savings and loan association or other institution, as defined in Section 3(a)(5)(A) of the Securities Act, whether acting in an individual or fiduciary capacity, ...

ALTERNATIVE DISTRIBUTION INFORMATION. To direct distribution to a party other than the registered owner, complete the information below. YOU MUST COMPLETE THIS SECTION IF THIS IS AN ▇▇▇ INVESTMENT. Name of Firm (Bank, Brokerage, Custodian): Account Name: Account Number: Representative Name: Representative Phone Number: Address: City, State, Zip: Name (Please Print) Name of Additional Purchaser Residence: Number and Street Address of Additional Purchaser City, State and Zip Code City, State and Zip Code Social Security Number Social Security Number