Common use of Telephone Number   Telephone Number Clause in Contracts

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Units subscribed for are to be registered in the following form of ownership: ❑ ownership (check one): □ Individual Ownership ❑ □ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ □ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ) : ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).) :

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Units of Common Stocks Stock subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ) : ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).) :

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Non-Patron Membership Interests subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Convertible Promissory Notess subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Convertibles subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Series A Units subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks BONDS subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Series CF Common Stocks subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ) : ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).) :

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Convertible Notes subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks SAFE Units subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Promissory Notes subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Units subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Series A Preferred Units subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Equitys subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ) : ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).) :

Telephone Number   Telephone Number. Residence Street Address Residence Street Address City, State & Zip Code (Must be same state as in Section 1) City, State & Zip Code (Must be same state as in Section 1) Mailing Address (Only if different from residence address) Mailing Address (Only if different from residence address) City, State & Zip Code City, State & Zip Code Email address Email address The Common Stocks Promissory Notess subscribed for are to be registered in the following form of ownership: ❑ Individual Ownership ❑ Joint Tenants with Right of Survivorship (both parties must sign). Briefly describe the relationship between the parties (e.g., married). ) : ❑ Tenants in Common (both parties must sign). Briefly describe the relationship between the parties (e.g., married).) :