<PAGE>

EXHIBIT 4.6

         NEITHER THESE SECURITIES NOR THE SECURITIES ISSUABLE UPON CONVERSION
         HEREOF HAVE BEEN REGISTERED WITH THE UNITED STATES SECURITIES AND
         EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE OR UNDER
         THE SECURITIES ACT OF 1933, AS AMENDED (THE "ACT"). THE SECURITIES ARE
         RESTRICTED AND MAY NOT BE OFFERED, RESOLD, PLEDGED OR TRANSFERRED
         EXCEPT IN ACCORDANCE WITH REGULATION S UNDER THE ACT, OR AS PERMITTED
         UNDER THE ACT PURSUANT TO REGISTRATION OR EXEMPTION OR SAFE HARBOR
         THEREFROM.

No.03-06-____                                                        US $350,000
                                                                        --------

                      ADVANCED TECHNOLOGY INDUSTRIES, INC.

                   9% CONVERTIBLE DEBENTURE DUE MARCH 24, 2007


        THIS DEBENTURE is one of a duly authorized issue of Debentures of
ADVANCED TECHNOLOGY INDUSTRIES, INC., a corporation duly organized and existing
under the laws of the State of Delaware (the "Company"), designated as its 9%
Convertible Debentures Due March 24, 2007.

         FOR VALUE RECEIVED, the Company promises to pay to CHICAGO VENTURE
PARTNERS, L.P, the registered holder hereof (the "Holder"), the principal sum of
THREE HUNDRED FIFTY THOUSAND DOLLARS (US $350,000) on March 24, 2007 (the
"Maturity Date") and to pay interest, on a simple non-compound basis, on the
principal sum outstanding from time to time in arrears upon the earlier of
conversion, redemption or the Maturity Date, as provided herein ("Interest
Payment Date") at the rate of 9% per annum. Accrual of interest shall commence
on the first business day to occur after the date hereof until payment in full
of the principal sum has been made or duly provided for. Subject to the
provisions of Section 4 below, the principal of, and interest on, this Debenture
are payable at the option of the Holder, in shares of Common Stock of the
Company, $.0001 par value ("Common Stock"), or in such coin or currency of the
United States of America as at the time of payment is legal tender for payment
of public and private debts, at the address last appearing on the Debenture
Register of the Company as designated in writing by the Holder from time to
time.

         This Debenture is being issued pursuant to the terms of the Securities
Purchase Agreement, dated as of even date (the "Securities Purchase Agreement"),
to which the Company and the Holder (or the Holder's predecessor in interest)
are parties. Capitalized terms not otherwise defined herein shall have the
meanings ascribed to them in the Securities Purchase Agreement.

         This Debenture is subject to the following additional provisions:

         1. The Debentures are issuable in denominations of Fifty Thousand
Dollars (US$50,000) and integral multiples thereof. The Debentures are
exchangeable for an equal aggregate principal amount of Debentures of different
authorized denominations, as requested by the Holders surrendering the same. No
service charge will be made for such registration or transfer or exchange.

         2. The Company shall be entitled to withhold from all payments of
principal of, and interest on, this Debenture any amounts required to be
withheld under the applicable provisions of the United States income tax laws or
other applicable laws at the time of such payments, and Holder shall execute and
deliver all required documentation in connection therewith.

         3. This Debenture has been issued subject to investment representations
of the original purchaser hereof and may be transferred or exchanged only in
compliance with the Securities Act of 1933, as amended (the "Act"), and other
applicable state and foreign securities laws and the terms of the Securities
Purchase Agreement. In the event of any proposed transfer of this Debenture, the
Company may require, prior to issuance of a new Debenture in the name of such
other person, that it receive reasonable transfer documentation including
opinions that the issuance of the Debenture in such other name does not and will
not cause a violation of the Act or any applicable state or foreign securities
laws. Prior to due presentment for transfer of this Debenture, the Company and
any agent of the Company may treat the person in whose name this Debenture is

<PAGE>

duly registered on the Company's Debenture Register as the owner hereof for the
purpose of receiving payment as herein provided and for all other purposes,
whether or not this Debenture be overdue, and neither the Company nor any such
agent shall be affected by notice to the contrary.

         4. (a) Subject to Section 4(b), from and after the date hereof, the
Holder of this Debenture is entitled, at its option, to convert at any time the
principal amount of this Debenture, provided that the principal amount is at
least US $10,000 (unless if at the time of such election to convert the
aggregate principal amount of all Debentures registered to the Holder is less
than Ten Thousand Dollars (US $10,000), then the whole amount thereof) and
accrued interest, into shares of Common Stock at a conversion price (the
"Conversion Price") for each share of Common Stock equal to the lesser of (i)
seven cents ($.07) as such price may be adjusted as provided herein (the "Fixed
Conversion Price") or (ii) 75% of the Market Price on the Conversion Date (as
defined below), as such price may be adjusted as provided herein (the "Variable
Conversion Rate"). For purposes of this Section 4, the Market Price shall be the
average of the lowest five (5) days closing bid prices (not necessarily
consecutive) of the Common Stock for the thirty (30) Trading Days immediately
preceding the Conversion Date, as reported by the Reporting Service, or, in the
event the Common Stock is listed on a stock exchange or traded on NASDAQ, the
Market Price shall be the closing prices on the exchange on such dates, as
reported in the Wall Street Journal.

                  (b) In the event that the Conversion Price shall be less than
$.07 as such price may be adjusted as provided herein (the "Redemption
Trigger"), the Holder may convert the principal amount of this Debenture only if
the Holder emails a notice to the Company, ATT: amk@ltdnetwork.com, advising the
Company of its intention to convert all or a specified amount of the principal
amount of this Debenture ("Stated Amount") within the fourteen (14) day period
(the "Redemption Period") after delivery of such notice ("Notice Date");
provided that the Holder shall not be entitled to submit a Notice of Conversion
(as defined below) until after the Reply Date (as defined below). Not later than
the end of the next business day following the Notice Date (the "Reply Date"),
the Company shall notify the Holder by email ([ ]) whether it elects to redeem
the Stated Amount in cash in lieu of permitting the Holder to so convert ("Reply
Notice"). In the event the Company does not timely deliver a Reply Notice, or
delivers a Reply Notice but elects not to redeem the Stated Amount, it shall not
be permitted to redeem the Stated Amount during the Redemption Period. In the
event the Company elects to redeem the Stated Amount, then thereafter with
respect to each Notice of Conversion delivered during the Redemption Period, the
Company shall pay an amount in immediately available funds (each a "Redemption
Amount") equal to (a) 150% of principal amount of this Debenture that is subject
to conversion in such applicable Notice of Conversion, plus (b) accrued and
unpaid interest with respect to such principal amount up to the Redemption Date,
and shall be paid to the Holder by the close of the third (3rd) business day
following the date on which the Holder faxes or otherwise delivers such Notice
of Conversion to the Company (any such date of redemption, the "Redemption
Date") in accordance with Section 5; provided that the aggregate of all such
principal amounts under all such Notices of Conversion delivered during the
Redemption Period shall not exceed the Stated Amount. In the event the payment
of the Redemption Amount is not timely made on the Redemption Date, any right of
redemption contained in this Section 4(b) shall thereafter permanently terminate
with respect to this Debenture, and the Company shall, with respect to any
conversions submitted during the Redemption Period, cause to be issued to the
Holder 105% of the number of shares of Common Stock otherwise required to be
delivered to the Holder in accordance with Section 4(a) with respect to
conversions of the lesser of (x) the Stated Amount and (y) and the principal
amount of this Debenture requested to be converted as set forth in any Notices
of Conversion. If the Holder does not deliver a Notice of Conversion during the
Redemption Period it must comply with the provisions of this Section 4(b) with
respect to any intended conversions following the Redemption Period. Nothing
contained in this Section 4(b) shall be deemed to obligate the Holder to submit
a Notice of Conversion during the Redemption Period. Furthermore, the Holder may
elect to forgo the redemption right set forth herein, and submit a Notice of
Conversion with a Conversion Price above the Redemption Trigger .

                  (c) Conversion shall be effectuated by faxing a Notice of
Conversion to the Company as provided in this Section 4(c). The Notice of
Conversion shall be executed by the Holder of this Debenture and shall evidence
such Holder's intention to convert this Debenture or a specified portion hereof
in the form annexed hereto as Exhibit A. The number of shares of Common Stock to
be issued in payment of any interest shall be determined by dividing the dollar
amount of the interest to be so paid by the Conversion Price on the relevant
Interest Payment Date. No fractional shares of Common Stock or scrip
representing fractions of shares will be issued on conversion, but the number of
shares issuable shall be rounded to the nearest whole share. The date on which


                                       2
<PAGE>

notice of conversion is given (the "Conversion Date") shall be deemed to be the
date on which the Holder faxes or otherwise delivers the conversion notice
("Notice of Conversion") to the Company so that it is received by the Company on
such specified date, provided that, if such conversion would convert the entire
remaining principal of this Debenture, the Holder shall deliver to the Company
the original Debentures being converted no later than five (5) business days
thereafter. Facsimile delivery of the Notice of Conversion shall be accepted by
the Company at facsimile number 212-532-2904; Attn: Allan Klepfisz. Certificates
representing Common Stock upon conversion ("Conversion Certificates") will be
delivered to the Holder at the address specified in the Notice of Conversion
(which may be the Holder's address for notices as contemplated by the Securities
Purchase Agreement or a different address), via express courier, by electronic
transfer or otherwise, within three (3) business days (such third business day,
the "Delivery Date") after the Conversion Date. The Holder shall be deemed to be
the holder of the shares issuable to it in accordance with the provisions of
this Section 4(c) on the Conversion Date.

         5. The principal of and interest on this Debenture shall be due and
payable on the Maturity Date, at the option of the Holder, in cash or in Common
Stock. If principal and interest is to be paid in Common Stock as contemplated
hereby, the number of shares of Common Stock to be issued in payment of such
principal and interest shall be determined by dividing the dollar amount of the
principal and interest to be so paid by the Conversion Price on the Maturity
Date. All payments contemplated hereby to be made "in cash" shall be made in
immediately available good funds of United States of America within three (3)
business days of the Interest Payment Date by wire transfer to an account
designated in writing by the Holder to the Company (which account may be changed
by notice similarly given). All payments of cash and each delivery of shares of
Common Stock issuable to the Holder as contemplated hereby shall be made to the
Holder at the address last appearing on the Debenture Register of the Company as
designated in writing by the Holder from time to time; except that the Holder
can designate, by notice to the Company, a different delivery address for any
one or more specific payments or deliveries.

         6. If, for as long as this Debenture remains outstanding, the Company
enters into a merger (other than where the Company is the surviving entity) or
consolidation with another corporation or other entity or a sale or transfer of
all or substantially all of the assets of the Company to another person
(collectively, a "Sale"), the Company will require, in the agreements reflecting
such transaction, that the surviving entity expressly assume the obligations of
the Company hereunder. Notwithstanding the foregoing, if the Company enters into
a Sale and the holders of the Common Stock are entitled to receive stock,
securities or property in respect of or in exchange for Common Stock, then as a
condition of such Sale, the Company and any such successor, purchaser or
transferee will agree that the Debenture may thereafter be converted on the
terms and subject to the conditions set forth above into the kind and amount of
stock, securities or property receivable upon such merger, consolidation, sale
or transfer by a holder of the number of shares of Common Stock into which this
Debenture might have been converted immediately before such merger,
consolidation, sale or transfer, subject to adjustments which shall be as nearly
equivalent as may be practicable. In the event of any such proposed Sale, the
Holder hereof shall have the right to convert by delivering a Notice of
Conversion to the Company within fifteen (15) days of receipt of notice of such
Sale from the Company, and Section 4(b) shall not apply to such conversion.

         7. If, at any time while any portion of this Debenture remains
outstanding, the Company spins off or otherwise divests itself of a part of its
business or operations or disposes of all or of a part of its assets in a
transaction (the "Spin Off") in which the Company, in addition to or in lieu of
any other compensation received and retained by the Company for such business,
operations or assets, causes securities of another entity (the "Spin Off
Securities") to be issued to security holders of the Company, the Company shall
cause (i) to be reserved Spin Off Securities equal to the number thereof which
would have been issued to the Holder had all of the Holder's Debentures
outstanding on the record date (the "Record Date") for determining the amount
and number of Spin Off Securities to be issued to security holders of the
Company (the "Outstanding Debentures") been converted as of the close of
business on the trading day immediately before the Record Date (the "Reserved
Spin Off Shares"), and (ii) to be issued to the Holder on the conversion of all
or any of the Outstanding Debentures, such amount of the Reserved Spin Off
Shares equal to (x) the Reserved Spin Off Shares multiplied by (y) a fraction,
of which (I) the numerator is the principal amount of the Outstanding Debentures
then being converted, and (II) the denominator is the principal amount of the
Outstanding Debentures.

         8. If, at any time while any portion of this Debenture remains
outstanding, the Company effectuates a stock split or reverse stock split of the
Common Stock or issues a dividend on the Common Stock consisting of shares of


                                       3
<PAGE>

Common Stock, the Fixed Conversion Price, the Redemption Trigger and any other
amounts calculated as contemplated hereby or by any of the other Transaction
Agreements shall be equitably adjusted to reflect such action. By way of
illustration, and not in limitation, of the foregoing, (i) if the Company
effectuates a 2:1 split of the Common Stock, thereafter, with respect to any
conversion for which the Company issues shares after the record date of such
split, the Fixed Conversion Price, the Redemption Trigger and any market price
from a date prior to such split which was used in the calculation of the
Conversion Price shall be deemed to be one-half of what it had been immediately
prior to such split; (ii) if the Company effectuates a 1:10 reverse split of the
Common Stock, thereafter, with respect to any conversion for which the Company
issues shares after the record date of such reverse split, the Fixed Conversion
Price, the Redemption Trigger and any market price from a date prior to such
split which was used in the calculation of the Conversion Price shall be deemed
to be ten times what it had been calculated to be immediately prior to such
split; and (iii) if the Company declares a stock dividend of one share of Common
Stock for every 10 shares outstanding, thereafter, with respect to any
conversion for which the Company issues shares after the record date of such
dividend, the Fixed Conversion Price, the Redemption Trigger and any market
price from a date prior to such split which was used in the calculation of the
Conversion Price shall be deemed to be such amount multiplied by a fraction, of
which the numerator is the number of shares (10 in the example) for which a
dividend share will be issued and the denominator is such number of shares plus
the dividend share(s) issuable or issued thereon (11 in the example).

         9. The Holder of the Debenture, by acceptance hereof, agrees that this
Debenture is being acquired for investment and that such Holder will not offer,
sell or otherwise dispose of this Debenture or the shares of Common Stock
issuable upon conversion thereof except under circumstances which will not
result in a violation of the Act or any applicable state Blue Sky or foreign
laws or similar laws relating to the sale of securities.

         10. This Debenture shall be governed by and construed in accordance
with the laws of the State of New York. The Company and, by acceptance of this
Debenture, the Holder consents to the exclusive jurisdiction of the federal
courts whose districts encompass any part of the City of New York or the state
courts of the State of New York sitting in the City of New York in connection
with any dispute arising under this Debenture and hereby waives, to the maximum
extent permitted by law, any objection, including any objection based on FORUM
NON COVENIENS, to the bringing of any such proceeding in such jurisdictions. To
the extent determined by such court, the Company shall reimburse the Holder for
any reasonable legal fees and disbursements incurred by the Holder in
enforcement of or protection of any of its rights under any of this Debenture.

         11. The Company and, by acceptance of this Debenture, the Holder hereby
waive a trial by jury in any action, proceeding or counterclaim brought by
either of the Parties hereto against the other in respect of any matter arising
out of or in connection with this Debenture.

         12. The following shall constitute an "Event of Default":

                  a.       The Company shall default in the payment of principal
                           or interest on this Debenture or any Redemption
                           Amount due hereunder or any other amount due under a
                           Transaction Agreement and, in any such instance, the
                           same shall continue for a period of five (5) business
                           days; or

                  b.       Any of the representations or warranties made by the
                           Company herein, in the Securities Purchase Agreement
                           or any of the other Transaction Agreements shall be
                           false or misleading in any material respect at the
                           time made; or

                  c.       In addition to the terms of the Securities Purchase
                           Agreement, the Company fails to authorize or to cause
                           its Transfer Agent to issue shares of Common Stock
                           upon exercise by the Holder of the conversion rights
                           of the Holder in accordance with the terms of this
                           Debenture, fails to transfer or to cause its Transfer
                           Agent to transfer any certificate for shares of
                           Common Stock issued to the Holder upon conversion of
                           this Debenture and when required by this Debenture or
                           the Registration Rights Agreement, and such transfer
                           is otherwise lawful, or fails to remove any
                           restrictive legend on any certificate or fails to
                           cause its Transfer Agent to remove such restricted
                           legend, in each case where such removal is lawful, as
                           and when required by this Debenture, the Securities
                           Purchase Agreement or the Registration Rights
                           Agreement, and any such failure shall continue
                           uncured for thirty (30) days; or


                                       4
<PAGE>

                  d.       The Company shall fail to perform or observe, in any
                           material respect, any other covenant, term,
                           provision, condition, agreement or obligation of any
                           Debenture in this series and such failure shall
                           continue uncured for a period of thirty (30) days
                           after written notice from the Holder of such failure;
                           or

                  e.       The Company shall fail to perform or observe, in any
                           material respect, any covenant, term, provision,
                           condition, agreement or obligation of the Company
                           under the Securities Purchase Agreement (other than
                           Section 5 thereof) and such failure shall continue
                           uncured for a period of thirty (30) days after
                           written notice from the Holder of such failure; or

                  f.       The Company shall (1) admit in writing its inability
                           to pay its debts generally as they mature; (2) make
                           an assignment for the benefit of creditors or
                           commence proceedings for its dissolution; or (3)
                           apply for or consent to the appointment of a trustee,
                           liquidator or receiver for its or for a substantial
                           part of its property or business; or

                  g.       A trustee, liquidator or receiver shall be appointed
                           for the Company or for a substantial part of its
                           property or business without its consent and shall
                           not be discharged within sixty (60) days after such
                           appointment; or

                  h.       Any governmental agency or any court of competent
                           jurisdiction at the instance of any governmental
                           agency shall assume custody or control of the whole
                           or any substantial portion of the properties or
                           assets of the Company and shall not be dismissed
                           within sixty (60) days thereafter; or

                  h.       Any money judgment, writ or warrant of attachment, or
                           similar process in excess of Five Hundred Thousand
                           ($500,000) Dollars in the aggregate shall be entered
                           or filed against the Company or any of its properties
                           or other assets and shall remain unpaid, unvacated,
                           unbonded or unstayed for a period of sixty (60) days
                           or in any event later than five (5) days prior to the
                           date of any proposed sale thereunder; or

                  i.       Bankruptcy, reorganization, insolvency or liquidation
                           proceedings or other proceedings for relief under any
                           bankruptcy law or any law for the relief of debtors
                           shall be instituted by or against the Company and, if
                           instituted against the Company, shall not be
                           dismissed within sixty (60) days after such
                           institution or the Company shall by any action or
                           answer approve of, consent to, or acquiesce in any
                           such proceedings or admit the material allegations
                           of, or default in answering a petition filed in any
                           such proceeding; or

                  j.       The Company shall have the Common Stock suspended
                           from trading on, or delisted from, the Principal
                           Trading Market for in excess of ten (10) Trading
                           Days; or

                  k.       Failure by the Company to pay when due any principal
                           of or interest on any other amount payable in respect
                           of one or more items of indebtedness for borrowed
                           money in an aggregate principal amount of $200,000,
                           in each case beyond the grace period, if any,
                           provided therefore (other than any such default in
                           existence prior to the date hereof that has been
                           disclosed to the initial Holder of this Debenture).

If an Event of Default shall have occurred, then, or at any time thereafter, and
in each and every such case, unless such Event of Default shall have been cured
or waived in writing by the Holder (which waiver shall not be deemed to be a
waiver of any subsequent default) at the option of the Holder and in the
Holder's sole discretion, the Holder may consider this Debenture immediately due
and payable (and the Maturity Date shall be accelerated accordingly), without
presentment, demand, protest or notice of any kinds, all of which are hereby
expressly waived, anything herein or in any note or other instruments contained
to the contrary notwithstanding, and the Holder may immediately enforce any and
all of the Holder's rights and remedies provided herein or any other rights or
remedies afforded by law.


                                       5
<PAGE>

         13. Nothing contained in this Debenture shall be construed as
conferring upon the Holder the right to vote or to receive dividends or to
consent or receive notice as a shareholder in respect of any meeting of
shareholders or any rights whatsoever as a shareholder of the Company, unless
and to the extent converted in accordance with the terms hereof.

         14. Notwithstanding any other provision hereof or of any of the other
Transaction Agreements, in no event (except (i) as specifically provided herein
as an exception to this provision, or (ii) while there is outstanding a tender
offer for any or all of the shares of the Common Stock) shall the Holder be
entitled to convert any portion of this Debenture, or shall the Company have the
obligation to convert such Debenture (and the Company shall not have the right
to pay interest hereon in shares of Common Stock) to the extent that, after such
conversion or issuance of stock in payment of interest, the sum of (1) the
number of shares of Common Stock beneficially owned by the Holder and its
Affiliates (other than shares of Common Stock which may be deemed beneficially
owned through the ownership of the unconverted portion of the Debentures or
other convertible securities or of the unexercised portion of warrants or other
rights to purchase Common Stock), and (2) the number of shares of Common Stock
issuable upon the conversion of the Debentures with respect to which the
determination of this proviso is being made, would result in beneficial
ownership by the Holder and its Affiliates of more than 4.99% of the outstanding
shares of Common Stock (after taking into account the shares to be issued to the
Holder upon such conversion). For purposes of the immediately preceding
sentence, beneficial ownership shall be determined in accordance with Section
13(d) of the Securities Exchange Act of 1934, as amended, except as otherwise
provided in clause (1) of such sentence.. The Holder, by its acceptance of this
Debenture, further agrees that if the Holder transfers or assigns any of the
Debentures to a party who or which would not be considered such an Affiliate,
such assignment shall be made subject to the transferee's or assignee's specific
agreement to be bound by the provisions of this Section 14 as if such transferee
or assignee were the original Holder hereof. Nothing herein shall preclude the
Holder from disposing of a sufficient number of other shares of Common Stock
beneficially owned by the Holder so as to thereafter permit the continued
conversion of this Debenture.

         15. Payment of this Debenture is secured pursuant to the terms of the
Security Agreement, dated July 19, 2005 (the "Security Agreement"), executed by
the Company, as debtor, in favor of the Collateral Agent therein, for the
benefit of the lenders thereto (including the Holder pursuant to a joinder
thereto). The terms of the Security Agreement are incorporated herein by
reference.

         16. In the event for any reason, any payment by or act of the Company
or the Holder shall result in payment of interest which would exceed the limit
authorized by or be in violation of the law of the jurisdiction applicable to
this Debenture, then IPSO FACTO the obligation of the Company to pay interest or
perform such act or requirement shall be reduced to the limit authorized under
such law, so that in no event shall the Company be obligated to pay any such
interest, perform any such act or be bound by any requirement which would result
in the payment of interest in excess of the limit so authorized. In the event
any payment by or act of the Company shall result in the extraction of a rate of
interest in excess of a sum which is lawfully collectible as interest, then such
amount (to the extent of such excess not returned to the Company) shall, without
further agreement or notice between or by the Company or the Holder, be deemed
applied to the payment of principal, if any, hereunder immediately upon receipt
of such excess funds by the Holder, with the same force and effect as though the
Company had specifically designated such sums to be so applied to principal and
the Holder had agreed to accept such sums as an interest-free prepayment of this
Debenture. If any part of such excess remains after the principal has been paid
in full, whether by the provisions of the preceding sentences of this Section or
otherwise, such excess shall be deemed to be an interest-free loan from the
Company to the Holder, which loan shall be payable immediately upon demand by
the Company. The provisions of this Section shall control every other provision
of this Debenture.

                  [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]


                                       6
<PAGE>

         IN WITNESS WHEREOF, the Company has caused this instrument to be duly
executed by an officer thereunto duly authorized.

Dated: March 24, 2006

                                   ADVANCED TECHNOLOGY INDUSTRIES, INC.

                                   By: ______________________________________

                                       Allan Klepfisz
                                       (Print Name)


                                       7
<PAGE>

                                    EXHIBIT A


                              NOTICE OF CONVERSION

   (To be Executed by the Registered Holder in order to Convert the Debenture)



         The undersigned hereby irrevocably elects to convert $ ________________
of the principal amount of the above Debenture No. ___ into shares of Common
Stock of ADVANCED TECHNOLOGY INDUSTRIES, INC. (the "Company") according to the
conditions hereof, as of the date written below.



Date of Conversion* _________________________________________

Accrued Interest      $__________________________

Applicable Conversion Price  ___________________________________________________


Signature ______________________________________________________________________
                                    [Name]

Address: _______________________________________________________________________

         _______________________________________________________________________