Common use of INDIVIDUAL INVESTORS Clause in Contracts

INDIVIDUAL INVESTORS. Investors that are not individuals (that is, are corporations, partnerships, trusts, etc.) should start at PART II. 1. Name (as it should appear on stock certificate): ______________________________________________________________________ 2. Residence address: ________________________________________________ ______________________________________________________________________ 3. Home telephone: __________________________________________________ 4. Date of birth: _____________________________________________________ 5. Social security number: _____________________________________________ 6. United States citizen: o Yes o No If no, country of citizenship:_______________________________________________ 7. Occupation: ____________________________________________________ 8. Number of years: _________________________________________________ 9. Present employer: __________________________________________________ 10. Position/Title: _____________________________________________________ 11. Business address: __________________________________________________ _______________________________________________________________________ 12. Business telephone: _________________________________________________

INDIVIDUAL INVESTORS. Investors that are not individuals (that is, are corporations, partnerships, trusts, etc.) should start at PART II. 1. Name (as it should appear on stock certificate): ______________________________________________________________________ 2. Residence address: ________________________________________________ ______________________________________________________________________ 3. Home telephone: _______________________________________________________________________ 4. Date of birth: __________________________________________________________________________ 5. Social security number: __________________________________________________________________ 6. United States citizen: ___________________________________________________________________ o Yes o No If no, country of citizenship:: ______________________________________________________________ 7. Occupation: __________________________________________________________________________ 8. Number of years: _______________________________________________________________________ 9. Present employer: ______________________________________________________________________ 10. Position/Title: _____________________________________________________ 11. Business address: __________________________________________________ _11. Business address: ______________________________________________________________________ 12. Business telephone: _____________________________________________________________________