Common use of Domicile/State of Organization Clause in Contracts

Domicile/State of Organization. The undersigned's state of domicile/organization is _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities of the Company. Dated: _________, 2012 __________________________ Address:_________________________ Signature of Investor Telephone:_______________________ Facsimile:________________________ Email:__________________________ __________________________ Print Name of Investor __________________________ Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "accredited investor" shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:

Domicile/State of Organization. The undersigned's ’s state of domicile/organization is is: _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state_. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities securities of the Company. Dated: _________, 2012 __________________________ Address:_________________________ Signature of Investor Investor(s) Telephone:_______________________ Facsimile:________________________ Email:__________________________ __________________________ Print Name of Investor Investor(s) __________________________ Print Title (if applicable) EXHIBIT A ALLOCATION OF WARRANTS AND DISCOUNT AMONG SUBSCRIBERS TO THIS OFFERING (For $3,412,500 principal value of notes issued through August 10, 2013) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "“accredited investor" ” shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:

Domicile/State of Organization. The undersigned's state of domicile/organization is _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities of the Company. Dated: _________, 2012 __________________________ Address:_________________________ Signature of Investor Subscriber(s) Telephone:_______________________ Facsimile:________________________ Email:__________________________ __________________________ Print Name of Investor Subscriber(s) __________________________ Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "accredited investor" shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:

Domicile/State of Organization. The undersigned's state of domicile/organization is _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities of the Company. Dated: _______October __, 2012 2011 __________________________ Address:_________________________ Signature of Investor Subscriber Telephone:_______________________ Facsimile:________________________ Email:__________________________ __________________________ Print Name of Investor Subscriber(s) __________________________ Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "accredited investor" shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:

Domicile/State of Organization. The undersigned's state of domicile/organization is _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities of the Company. Dated: _________, 2012 __________________________ Address:_________________________ Signature of Investor Telephone:_______________________ FacsimileFax:________________________ Email:__________________________ __________________________ Print Name of Investor __________________________ Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "accredited investor" shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:

Domicile/State of Organization. The undersigned's state of domicile/organization is _______________ and the undersigned was solicited to purchase the securities in such state and is executing this Investor Questionnaire in such state. The foregoing representations are true and accurate as of the date hereof. The undersigned undertakes to notify the Company regarding any material change in the information set forth above prior to the purchase by the undersigned of any Closing Securities of the Company. Dated: _________, 2012 2011 __________________________ Address:_________________________ Signature of Investor Subscriber Telephone:_______________________ Facsimile:________________________ Email:__________________________ __________________________ Print Name of Investor Subscriber(s) __________________________ Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D ("Regulation D") under the United States Securities Act of 1933, as amended (the "Act"). As used in Regulation D, the term "accredited investor" shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person: