and regulations thereunder. The undersigned also
acknowledges that it understands that the answers to this Questionnaire are
furnished for use in connection with Registration Statements filed pursuant to
the Registration Rights Agreement and any amendments or supplements thereto
filed with the Commission pursuant to the Securities Act.
I confirm that, to the best of my knowledge and belief, the foregoing statements
(including without limitation the answers to this Questionnaire) are correct.
IN WITNESS WHEREOF the undersigned, by authority duly given, has caused this
Questionnaire to be executed and delivered either in person or by its duly
authorized agent.
Dated: ____________________________ Beneficial Owner: ________________________
By:
Name:
Title:
EXHIBIT C
WIRE INSTRUCTIONS
[Intentionally omitted.]
C-1
EXHIBIT D-1
ACCREDITED INVESTOR QUESTIONNAIRE
[Intentionally omitted.]
D-1-1
EXHIBIT D-2
STOCK CERTIFICATE QUESTIONNAIRE
[Intentionally omitted.]
D-2-1
EXHIBIT E
FORM OF SECRETARY'S CERTIFICATE
[Intentionally omitted.]
E-1
EXHIBIT F
FORM OF OFFICER'S CERTIFICATE
[Intentionally omitted.]
F-1
Schedule A
OPINIONS
[Intentionally omitted.]
Schedule A-1
Schedule B
SUBSIDIARIES
[Intentionally omitted.]
Schedule B-1