Common use of Domicile/State of Organization Clause in Contracts

Domicile/State of Organization. The undersigned’s state of domicile/organization is: . 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 Securities of the Company. Dated: Address: Signature of Investor(s) Telephone: Facsimile: Email: Print Name of Investor(s) Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D under 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: . 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 Securities of the Company. Dated: Address: Signature of Investor(sSubscriber(s) Telephone: Facsimile: Email: Print Name of Investor(sSubscriber(s) Print Title (if applicable) ATTACHMENT 1 Rule 501. Definitions and Terms Used in Regulation D under 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: