Document:

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Exhibit
4.9

XENI FINANCIAL SERVICES, CORP.

PROMISSORY
NOTE

U.S. $55,000August 24,
2006

THIS PROMISSORY NOTE (this
‘‘Note’’) is made as of this 24th day of
August, 2006 by Xeni Financial Services, Corp., a corporation
incorporated under the laws of State of Florida
(‘‘Maker’’), in favor of Eugene Grenier or his
assigns (‘‘Payee’’).

RECITALS

WHEREAS, Payee has loaned to the
Maker the principal sum of Fifty Five Thousand Dollars ($55,000).

NOW, THEREFORE, for and in consideration of the mutual
agreements herein contained, and for and in consideration of other good
and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged, Maker and Payee hereby covenant and agree as set
forth below. All capitalized terms used herein and not otherwise
defined shall have the meaning ascribed to such terms in the Purchase
Agreement.

 

FOR VALUED RECEIVED, Maker
hereby promises to pay to the order of Payee, the principal sum of
FIFTY FIVE THOUSAND DOLLARS ($55,000), or such lesser amount as may
from time to time be otherwise owing from Maker to Payee under this
Note, together with interest on the principal amount from time to time
outstanding hereunder accrued from the date hereof at the rate and in
the manner set forth below. All payments of principal or interest or
both shall be paid as set forth below, and each such payment shall be
made in lawful money of the United States of America.

This Note
is subject to the following terms and conditions:

			
		1. 	Payments of Principal
and
Interest.

(a)    Repayment.    Unless
otherwise repaid as provided herein, the entire unpaid principal
balance of this Note, together with all accrued but unpaid interest
thereon, shall be due and payable in full on the date that is One
Hundred Fifty (150) days following the date hereof (the
‘‘Maturity Date’’), except that if such date is
not a day on which commercial banks or governmental offices are open
for business in the State of Florida (a ‘‘Business
Day’’) then the Maturity Date shall be the next day that is
a Business Day. The Maker of the note shall be entitled to one (1)
sixty (60) day extension of the Maturity Date.

(b)    Late Fee Upon Failure To Repay.    If
Maker fails to repay this Note on or prior to the Maturity Date or such
earlier date resulting from the acceleration of the date upon which the
principal amount of this Note shall be payable in accordance with the
terms of this Note (due to an Event of Default or otherwise), the
interest rate on the outstanding principal amount, accrued and unpaid
interest and all other amounts due hereunder shall increase to a rate
of twelve percent (12%) per annum, until all amounts owing on
this Note are repaid in full.

(c)    Optional
Prepayment.    Maker shall be entitled, at its option, to prepay
part of or all the outstanding principal amount of this Note, and
accrued interest thereon free of any prepayment penalties or charges
(the ‘‘Outstanding Balance’’).

(d)    Manner of Payment.    Maker shall make
payment in accordance with the terms of this Note no later than 5:30
p.m. (New York City time) on the date when due, in immediately
available funds. Each payment of principal and of interest shall be
paid by Maker without setoff or counterclaim to Payee at Payee's
address set forth in the Purchase Agreement, or to such other location
or accounts within the United States as Payee may specify in writing to
Maker from time to time, in immediately available funds or as otherwise
explicitly provided for herein.

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(e)    Cancellation.    After
all amounts owed on this Note have been paid in full Payee shall
surrender this Note to Maker for cancellation and this Note will not be
reissued.

			
		2. 	Interest
Rate.

(a)    Subject to Section 1(b), this
Note will bear interest at the rate equal to ten percent (10%)
per annum, commencing the date hereof to and including the date of
payment of the Outstanding Balance of this Note. Interest on this Note
shall be calculated on the basis of actual days elapsed in a 365-day
year.

(b)    Interest on this Note shall be due and
payable in arrears on the Maturity Date.

			
		3. 	Events of
Default.    The following are ‘‘Events of
Default’’ hereunder:

(a)    any failure by
Maker to pay when due the Outstanding Balance;

(b)    if Maker shall (i) apply for or consent to the
appointment of a receiver, trustee, custodian or liquidator or any of
its property, (ii) admit in writing its inability to pay its debts as
they mature, (iii) make a general assignment for the benefit of
creditors, (iv) be adjudicated bankrupt or insolvent or be the subject
of an order for relief under Title 11 of the United States Bankruptcy
Code, (v) file a voluntary petition in bankruptcy or a petition for
bankruptcy, reorganization, insolvency, readjustment of debt,
dissolution or liquidation, or an answer admitting the material
allegations of a petition filed against it in any proceeding under any
such law and such petition or proceeding shall remain undismissed or
unstayed for thirty (30) days, or (vi) take or permit to be taken any
action in furtherance of or for the purpose of effecting any of the
foregoing;

(c)    any dissolution, liquidation or
winding up of Maker or any substantial portion of its business; and

(d)    any cessation of operations by Maker or Maker is
otherwise generally unable to pay its debts as such debts become
due.

4.       Remedies on
Default.    If any Event of Default shall occur and be
continuing, then the entire Outstanding Balance shall become
immediately due and payable, without notice or demand.

5.       Certain
Waivers.    Except as otherwise expressly provided in this
Note, Maker hereby waives diligence, demand, presentment for payment,
protest, dishonor, nonpayment, default and notice of any and all of the
foregoing.

6.       No
Impairment.    Maker will not, by amendment of its articles
of incorporation, bylaws, or through reorganization, consolidation,
merger, dissolution, sale of assets, or another voluntary action, avoid
or seek to avoid the observance or performance of any of the terms of
this Note, but will at all times in good faith assist in the carrying
out of all such terms and in the taking of all such action as may be
necessary or appropriate in order to protect the rights of Payee
against impairment.

7.       Amendments.    This
Note may not be changed orally, but only by an agreement in writing and
signed by the party against whom enforcement of any waiver, change,
modification or discharge is sought.

			
		8. 	Governing Law;
Jurisdiction; Waiver Of Jury Trial.

THIS NOTE
SHALL BE DEEMED TO BE A CONTRACT MADE UNDER THE LAWS OF THE STATE OF
FLORIDA AND SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE
LAWS OF THE STATE OF FLORIDA. MAKER HEREBY IRREVOCABLY AND
UNCONDITIONALLY SUBMITS, FOR ITSELF AND ITS PROPERTY, TO THE
NONEXCLUSIVE JURISDICTION OF THE SUPREME COURT OF THE STATE OF FLORIDA
SITTING IN THE COUNTY OF BROWARD AND OF THE UNITED STATES DISTRICT
COURT OF THE SOUTHERN DISTRICT OF FLORIDA, AND ANY APPELLATE COURT FROM
ANY THEREOF, IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO
THIS NOTE, OR FOR RECOGNITION OR ENFORCEMENT OF ANY JUDGMENT, AND EACH
OF THE PARTIES HERETO HEREBY IRREVOCABLY AND UNCONDITIONALLY AGREES
THAT ALL CLAIMS IN RESPECT OF ANY SUCH ACTION OR PROCEEDING MAY BE
HEARD AND DETERMINED IN SUCH FLORIDA OR, TO THE EXTENT PERMITTED BY
LAW, IN SUCH FEDERAL COURT. NOTHING IN THIS NOTE OR ANY OTHER LOAN
DOCUMENT WILL 

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AFFECT THE RIGHT OF ANY PARTY TO THIS NOTE TO
SERVE PROCESS IN ANY OTHER MANNER PERMITTED BY LAW. MAKER HEREBY
WAIVES THE RIGHT TO TRIAL BY JURY IN ANY ACTION OR PROCEEDING FOR THE
ENFORCEMENT OR COLLECTION OF THIS NOTE.

9.       Notices.    Any
notice, request, demand or other communication permitted or required to
be given hereunder shall be in writing and shall be deemed to have been
given hereunder when it (a) shall have been sent by certified or
registered United States mail, postage pre-paid, or (b) shall have been
delivered, in either case, if to the Maker, to its principal executive
offices at 1020 NW 6th Street, Suite I, Deerfield Beach, FL
33442, and if to the payee to 2 Marc Road, Danbury, Connecticut 06810,
or such other address as shall hereafter be designated by notice in
writing.

10.    Transaction and
Enforcement Costs.    In the event that Payee shall, after
the occurrence and during the continuance of an Event of Default (and
provided that Payee shall be permitted, at such time, to enforce its
rights hereunder and retain payments received hereunder), turn this
Note over to an attorney for collection, Maker shall further be
obligated to Payee for Payee's reasonable attorneys' fees
and expenses incurred in connection with such collection as well as any
other reasonable costs incurred by Payee in connection with the
collection of all amounts due hereunder.

11.    Loss, Theft, Destruction or
Mutilation of Note.    Upon notice by Payee to Maker of the
loss, theft, destruction or mutilation of this Note, and upon surrender
and cancellation of this Note, if mutilated, Maker, as its expense,
will make and deliver a new note of like tenor, in lieu of this Note;
provided, however, prior to issuance of a new Note,
Maker may require Payee to provide Maker an affidavit and indemnity
regarding any lost or mutilated Note.

12.    Successors and
Assigns.    This Note and the obligations and rights of
Maker hereunder, shall be binding upon and inure to the benefit of
Maker, the Payee, and their respective successors and assigns.

13.    Severability.    In the
event that any provision of this Note becomes or is declared by a court
of competent jurisdiction to be illegal, unenforceable or void, this
Note will continue in full force and effect without said provision and
the parties agree to replace such provision with a valid and
enforceable provision that will achieve, to the extent possible, the
economic, business and other purposes of such provisions; provided,
however, that no such severability will be effective against a
party if it materially and adversely changes the economic benefits of
this Note to such party.

14.    Further
Assurances.    Maker and its agents shall each cooperate
with Payee and use (or cause its agents to use) its commercially
reasonable best efforts to promptly (i) take or cause to be taken all
necessary actions, and do or cause to be done all things necessary,
proper or advisable under this Note and applicable laws to consummate
and make effective all transactions contemplated by this Note as soon
as practicable following the request of Payee, and (ii) obtain all
approvals required to be obtained from any third party necessary,
proper or advisable to the transactions contemplated by this Note.

15.    Usury.    Notwithstanding
any provision to the contrary contained in this Note, or any and all
other instruments or documents executed in connection herewith, Maker
and Payee intend that the obligations evidenced by this Note conform
strictly to the applicable usury laws from time to time in force. If,
under any circumstances whatsoever, fulfillment of any provisions
thereof or any other document, at the time performance of such
provisions shall be due, shall involve transcending the limit of
validity prescribed by law, then, ipso facto, the obligation to
be fulfilled shall be reduced to the limit of such
validity.

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IN WITNESS WHEREOF, Maker has duly
caused this Note to be signed on its behalf, in its company name and by
its duly authorized officer as of the date first set forth above.

XENI FINANCIAL SERVICES, CORP.

				
	By:			/s/ Vincent
Colangelo                    
	Name:			Vincent
Colangelo
	Title:			Chief Financial
Officer
	

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Exhibit
10.10

MDWERKS, INC.

SUBSCRIPTION AGREEMENT

MDwerks, Inc.
 1020 NW 6th Street
– Suite 1
 Deerfield Beach, FL 33442

Gentlemen:

1.    SUBSCRIPTION.    The
undersigned hereby makes application to acquire Fifty Five Thousand
($55,000.00) Dollars principal amount of a 10% promissory note
due in One Hundred and Fifty (150) days, with maker entitled to one 60
day extension (‘‘Note’’), and Five Thousand
(5,000) shares of the Common Stock of MDwerks, Inc. (the
‘‘Company’’), pursuant to the terms of this
Subscription Agreement. This Subscription may be rejected by the Board
of Directors of the Company and shall not be binding upon the Company,
until executed by the Company.

2.    REPRESENTATION BY THE
UNDERSIGNED.    The undersigned represents and warrants as
follows:

(a)    The undersigned has relied only on the
good faith information provided in writing by the Company, has not
relied on any oral representations, has been given ample time and has
had the opportunity to ask questions, and has been given access to full
and complete information regarding the Company;

(b)    The undersigned recognizes that the Note have not
been registered under the Securities Act of 1933 (the
‘‘Securities Act’’), as amended, nor under the
securities laws of any state and the undersigned has no right to
require such registration and no registration is contemplated;

(c)    The undersigned believes that an investment in the
Company is suitable based upon the undersigned's investment
objectives and financial needs, and the undersigned has no need for
liquidity of this investment with respect to the Note;

(d)    The undersigned has the requisite knowledge to
assess the relative merits and risks, is capable of interpreting
financial statements, or has relied upon the advice of counsel,
accountants and/or purchaser representative(s) with regard to tax
aspects, risks and other considerations involved in the investment, and
fully understands that the undersigned must look to the
undersigned's own advisors with respect to the tax consequences,
risks and other considerations in connection with investing in the
Company and has consulted with the undersigned's own independent
counsel or advisors regarding the tax consequences, risks and other
considerations involved in the investment;

(e)    The
undersigned is acquiring the Note for long-term investment and not with
a view toward resale, fractionalization or division or distribution
thereof;

(f)    The undersigned realizes that the Note
can not readily be sold as there will be no public market, that it may
not be possible to sell or dispose of the Note and therefore the Note
must not be purchased, unless the undersigned has liquid assets
sufficient to assure that such purchase will cause no undue financial
difficulties and the undersigned can provide for current needs and
possible personal contingencies;

(g)    All
information which the undersigned has provided to the Company
concerning the undersigned's financial position and knowledge of
financial business matters is correct and complete as of the date set
forth at the end hereof, and if there should be any material change in
such information prior to acceptance of this Subscription Agreement by
the Board of Directors, the undersigned will immediately provide the
Board of Directors with such information;

(h)    The
undersigned understands that the books and records of the Company will
be available upon reasonable notice for inspection during reasonable
business hours at the Company's place of business;

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(i)    The undersigned has been
provided access to all information requested by the undersigned;

(j)    The Note is being purchased by the undersigned in
the undersigned's name solely for the undersigned's own
beneficial interest and not as nominee for, or on behalf of, or for the
beneficial interest of, or with the intention to transfer to, any other
person, trust or organization;

(k)    The undersigned
is aware that there are certain specific informational requirements
which the Company must meet in connection with an offering to any
person who is not an Accredited Investor (as defined in Rule 501),
pursuant to Rule 501 of Regulation D of the rules and regulations of
the Securities and Exchange Commission (‘‘Rule
501’’). There are no such specific informational
requirements for offerings to Accredited Investors (as defined in Rule
501). The Company is making the offer and sale of the Note to the
undersigned in reliance on the representations by the undersigned that
the undersigned is an Accredited Investor (as defined in Rule 501), and
the undersigned so acknowledges and reaffirms that the undersigned is
an Accredited Investor (as defined in Rule 501); and

(l)    The undersigned is willing and able to bear the
economic risk and loss of an investment in the Company in an amount
equal to the total purchase price of the Note for which the undersigned
is subscribing pursuant to this Subscription Agreement. In making this
statement, consideration has been given to whether the undersigned
could afford a complete loss of the undersigned's investment.

(m)    Without limiting the foregoing, the undersigned
represents that he has read, is aware of and understands the risk
factors relative to an investment in the Company set forth in the
Company's Registration Statement on Form SB-2 (Registration No.
333-132296), as amended.

3.    INDEMNIFICATION.    The undersigned acknowledges
that he understands the meaning and legal consequences of the
representations, warranties, and covenants in Sections 2, 4 and 5
hereof and that the Company has relied upon such representations,
warranties, and covenants, and the undersigned hereby agrees to
indemnify and hold harmless the Company and its controlling persons
from and against any and all loss, damage or liability due to or
arising out of a breach of any such representation, warranty, or
covenant. Notwithstanding the foregoing, however, no representation,
warranty, acknowledgment, or agreement made herein by the undersigned
shall in any manner be deemed to constitute a waiver of any rights
granted to the undersigned under federal or state securities laws. All
representations, warranties, and covenants in this Subscription
Agreement and the indemnification contained in this Section  3
shall survive the acceptance of this Subscription Agreement and the
issuance of the Note to the undersigned.

4.    LIMITATIONS
ON TRANSFER OF NOTE.    The undersigned acknowledges that the
undersigned is aware that there are substantial restrictions on the
transferability of the Note. The undersigned agrees that the Note may
not be sold unless (a) such sale is pursuant to an effective
registration statement under the Securities Act and all relevant state
securities laws or (b) the Company shall have been advised by its
counsel that such registration is not required and that such sale is
exempt from registration under the Securities Act and any other
applicable state securities laws or regulations. The undersigned agrees
that the undersigned will give appropriate notice of these restrictions
to each person to whom he transfers Note.

5.    COMPLIANCE
WITH SECURITIES LAWS.    The undersigned understands and agrees
that the following restrictions and limitations are applicable to the
undersigned's purchase and resale, pledge, hypothecation, or
other transfer of the Note, pursuant to the Securities Act, as
amended.

(a)    The undersigned agrees that the Note
may not be sold, pledged, hypothecated, or otherwise transferred unless
registered under the Securities Act and all applicable state securities
laws or exempted therefrom.

(b)    A legend in
substantially the following form has been or will be placed on the Note
issued to the undersigned:

THIS NOTE HAS NOT
BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933. THIS NOTE HAS BEEN
ACQUIRED FOR INVESTMENT AND MAY NOT BE SOLD, TRANSFERRED OR ASSIGNED IN
THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES
ACT OF 1933 OR AN OPINION OF THE COMPANY'S COUNSEL THAT
REGISTRATION IS NOT REQUIRED UNDER SAID ACT.

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(c)    The legends described in
subparagraph (b) above will be placed on any new Note issued upon
presentment by the undersigned of any Note issued to the undersigned
for transfer.

6.    PIGGYBACK REGISTRATION
RIGHTS.

(a)    If the Company proposes to file a
registration statement under the Securities Act with respect to an
offering of equity securities (A) for the Company's own account
or (B) for the account of any of the holders of its equity securities,
then the Company shall give written notice of such proposed filing to
the undersigned as soon as practicable (but in no event less than ten
(10) days before the anticipated filing date), and such notice shall
offer the undersigned the opportunity to register such number of shares
of common stock of the Company (‘‘Common
Stock’’) underlying the Warrant (if any, as a part of this
transaction) as the undersigned may request on the same terms and
conditions as the Company's or the holders of equity securities
included in such registration statement (a ‘‘Piggyback
Registration’’). If the undersigned desires to have his
Common Stock included in such registration statement, the undersigned
shall so advise the Company in writing (stating the number of shares of
Common Stock desired to be registered) within five (5) days after the
date of such notice from the Company. The Undersigned shall have the
right to withdraw such request for inclusion of shares of Common Stock
in any registration statement pursuant to this section by giving
written notice to the Company of such withdrawal prior to the effective
date of the registration statement. Subject to Section 6(b) below, the
Company shall include in such registration statement all such Common
Stock requested to be included therein; provided,
however, that the Company may at any time withdraw or cease
proceeding with any such registration if it shall at the same time
withdraw or cease proceeding with the registration of all other
securities originally proposed to be registered.

(b)    Notwithstanding anything contained herein, if the
managing underwriter of an offering described in Section 6(a) above
delivers a written opinion to the Company that marketing considerations
require a limitation on the number of shares offered pursuant to any
registration statement, then the Company shall include in such
registration (A) first, the securities being offered for the account of
the Company, and (B) second, the number of shares of Common Stock
requested to be include that, in the opinion of such Underwriter, can
be sold.

(c)    In the case of the registration of any
underwritten primary offering initiated by the Company (other than any
registration by the Company on Form S-4 or Form S-8 (or any successor
or substantially similar form), or of (A) an employee stock option,
stock purchase or compensation plan or of securities issued or issuable
pursuant to any such plan, or (B) a dividend reinvestment plan) or any
underwritten secondary offering initiated at the request of a holder of
securities of the Company (a ‘‘Registration Rights
Holder’’) pursuant to registration rights granted by the
Company, the undersigned agrees not to effect any public sale or
distribution of securities of the Company during the period beginning
fifteen (15) days prior to the closing date of such underwritten
offering and during the period ending on ninety (90) days after such
closing date (or such longer period, not to exceed one hundred fifty
(150) days, as may be reasonably requested by the Company or by the
managing underwriter or underwriters).

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THE UNDERSIGNED REPRESENTS THE
UNDERSIGNED HAS READ THIS SUBSCRIPTION AGREEMENT AND THE OFFEREE
QUESTIONNAIRE AND FULLY UNDERSTANDS THE TERMS CONTAINED THEREIN AND
HEREIN

EXECUTED BY THE UNDERSIGNED this the 24 day of August
2006.

				
	                                                            

Subscriber printed
name			                                                            
Signature
	 			                                                            
Print
Name of Signatory
	 			                                                            

Title of
Signatory
	                                                            

Social Security or Taxpayer ID#			 
	Address:			 
	                                                            

Street			 
	                                                            

City         State         Zip			 
	                                                            

Telephone Number			 
	

ACCEPTED BY
MDWERKS, INC.,
 this the 24th day of August,
2006.

		
	By: 	                                                                                

Howard B. Katz, Chief Executive Officer

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TYPE OF OWNERSHIP (CHECK
ONE)

				
	INDIVIDUAL
OWNERSHIP
(one signature
required)
    
                                                                                        			COMMUNITY
PROPERTY (one signature if Interest is in one name, i.e. managing
spouse;
two signatures required if Interest is held in both
names)
    
                                                                                        
	 			 
	JOINT
TENANTS WITH RIGHT OF SURVIVORSHIP (Both parties must
sign)
    
                                                                                        			TENANTS
IN COMMON
 (both parties must
sign)
    
                                                                                        
	 			 
	TRUST
(Please include name of trust, name of trustee, date trust was formed
and copy of the
Trust Agreement or other
authorization)
    
                                                                                        			CORPORATION
(Please include certified
corporate resolution authorizing
signature)
    
                                                                                        
	 			 
	PARTNERSHIP
(Please indicate type and
include a copy of the Statement of
Partnership or
Partnership Agreement authorizing
signature)
    
                                                                                        			 
	

                                                                                                                                    

Please print here the exact name
Subscriber desires on records of
the Company.

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ALL INFORMATION WILL BE TREATED
CONFIDENTIALLY

MDWERKS, INC.

OFFEREE
QUESTIONNAIRE

MDwerks, Inc.
 1020 NW 6th
Street – Suite 1
 Deerfield Beach, FL 33442

Gentlemen:

The information contained herein is being
furnished by the undersigned in order to determine whether the
undersigned's Subscription Agreement to purchase a 10%
promissory note due in One Hundred and Fifty (150) days, with maker
entitled to one 60 day extension in the original principal amount of
Fifty Five Thousand and 00/100 ($55,000.00) Dollars (the
‘‘Note’’), of MDwerks, Inc., a Delaware
corporation (the ‘‘Company’’'), may be
accepted by the Company pursuant to Section 4(2) and/or Regulation D of
the Securities Act of 1933, as amended (the
‘‘Mct’’). The undersigned understands that (a)
the Company will rely upon the information contained herein for
purposes of determining the availability of said exemptions and (b) the
Note will not be registered under the Act in reliance upon the
exemption from registration afforded by Section 4(2) of the Act and
Regulation D thereunder.

All information furnished is for the
sole use of the Company on behalf of the Company and will be held in
confidence by the Company, except that this Questionnaire may be
furnished to such parties as the Company deems desirable to establish
compliance with federal or state securities laws.

In accordance
with the foregoing, the following representations and information are
hereby made:

		
	1. 	The undersigned has
knowledge and experience in financial and business matters so as to be
capable of evaluating the relative merits and risks of an investment in
the Company; the undersigned is not utilizing the services of a
representative (‘‘Purchaser Representative’’)
in connection with evaluating such merits and risks. The undersigned
offers as evidence of knowledge and experience in these matters the
information requested below on this Offeree Questionnaire.

		
	2. 	The undersigned is willing and able
to bear the economic risk of an investment in the Company in an amount
equal to the total subscription amount. In making this statement,
consideration has been given to whether the undersigned could afford a
complete loss. The undersigned offers, as evidence of ability to bear
the economic risk, the information below on this Offeree
Questionnaire.

		
	3. 	Except as
indicated below, the purchase of the Note will be solely for the
account of the undersigned, and not for the account of any other person
or with a view to any resale, fractionalization, division, or
distribution thereof.

(Please state ‘‘No
Exceptions’’ or set forth exceptions to the representation
set forth above in this Section 3 and give details. Attach additional
pages if necessary.)

	
			
	

	
			
	

		
	4. 	The
undersigned represents to the Company that (a) the information
contained herein is complete and accurate and may be relied upon by the
Company and (b) the undersigned will notify the Company immediately of
any material change in any of such information occurring prior to
acceptance of the Subscription Agreement for the purchase of the Note
by the undersigned.

INFORMATION REQUIRED OF EACH
PROSPECTIVE PURCHASER:

		
	A. 	General Information

		
	1. 	Name:
                                                                

		
	2. 	Address, Telephone Number and
Facsimile Number:
                                                                                    

	
			
	

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	3. 	Address for
notice purposes:
                                                                                                                            

	
			
	

		
	4. 	If
applicable, Employer or business association and position:
                                                                    

	
			
	

		
	5. 	If
applicable, U.S. Taxpayer Identification Number or Social Security
Number:
                                      

		
	B. 	Accredited Investor Status

PLEASE CHECK APPROPRIATE BOX TO VERIFY THE UNDERSIGNED'S
STATUS AS AN ACCREDITED INVESTOR. THIS INFORMATION IS SOLELY FOR BOARD
OF DIRECTOR'S RECORDS AND CONSTITUTES A MATERIAL PART OF THESE
EXECUTION DOCUMENTS. FAILURE TO COMPLETE WILL DISQUALIFY A PROSPECTIVE
PURCHASER FROM BEING ABLE TO PURCHASE NOTE FROM THE COMPANY. FAILURE TO
QUALIFY UNDER ONE OF CATEGORIES 1 THROUGH 9 WILL RENDER A PROSPECTIVE
PURCHASER UNSUITABLE FOR THIS INVESTMENT.

The undersigned
is:

							
	 			1.			A
natural person whose individual net worth, or joint net worth with that
person's spouse, at the time of his purchase exceeds
$1,000,000.
	 			2.			A natural
person who had individual income in excess of $200,000 in each of the
two most recent years and who reasonably expects individual income in
excess of $200,000 in the current year or joint income with that
person's spouse in excess of $300,000 in each of these years and
expects to have at least that much in the current year.
	 			3.			A director or executive officer of
the issuer of the securities being offered or sold, or any director,
executive officer, general partner of a general partner or manager of a
manager of that issuer.
	 			4.			A bank as defined in Section
3(a)(2) of the Act, or a savings and loan association or other
institution as defined in Section 3(a)(5)(A) of the Act whether acting
in its individual or fiduciary capacity; any broker or dealer
registered pursuant to Section  15 of the Securities Exchange Act
of 1934; an insurance company defined in Section  2 (13) of the
Act; an investment company registered under the Investment Company Act
of 1940 or a business development company as defined in Section
2(a)(48) of that Act; Small Business Investment Company licensed by the
United States Small Business Administration under Section 301(c) or (d)
of the Small Business Investment Act of 1958; employee benefit plan
within the meanings of Title I of the Employee Retirement Income
Security Act of 1974, if the investment decision is made by a plan
fiduciary, as defined in Section 3(21) of such Act, which is either a
bank, insurance company or registered investment adviser, or if the
employee benefit plan has total assets in excess of
$5,000,000.
	 			5.			A private
business development company as defined in Section 202(a)(22) of the
Investment Advisers Act of 1940.
	 			6.			An organization described in
Section 501(c)(3) of the Internal Revenue Code or a corporation with
total assets in excess of $5,000,000 and not formed for the purpose of
acquiring the Common Stock.
	 			7.			An insurance company as defined in
Section 2(13) of the Act.
	 			8.			A trust with total assets in
excess of $5,000,000 not formed for the specific purpose of acquiring
Common Stock, whose purchase is directed by a person with such
knowledge and experience in financial and business matters as to be
capable of evaluating the merits and risks of an investment in the
Company.
	

7

Table of Contents

							
	 			9.			An entity
in which all of the equity owners are accredited investors (as defined
in Rule 501 of Regulation D of the rules and regulations of the
Securities and Exchange Commission.
	 			10.			None of the
above.
	

		
	3. 	EDUCATION
BACKGROUND

School(s) and Degrees:
                                                                                                                                    

	
			
	

	
			
	

	
			
	

	
			
	

	
			
	

		
	D. 	BUSINESS
AND EMPLOYMENT INFORMATION

Name of Employer or Business:
                                                                                                                    

Nature of Business:
                                                                                                                                            

Position and Duties:
                                                                                                                                            

	
			
	

Prior occupations during past
five years:

	
			
	

	
			
	

	
			
	

	
			
	

		
	1. 	I
have personally invested in excess of
$                                                
over the past five years, including investments during such periods in
excess of
$                                             
in investments not registered for sale to the public under applicable
federal and state securities
laws.

		
	2. 	I consider myself to be an
experienced and sophisticated investor and I have such knowledge and
experience in financial and business matters that I am capable of
evaluating the merits and risks of an investment in the Note offered by
the Company:

Yes             No

		
	3. 	I
understand the full nature and risk of investment in the Note and the
Warrant offered by the Company, and I feel I can afford the complete
loss of the investment:

Yes            
No

		
	4. 	Set forth below are the types of
private investments I have made in the past five years, with particular
attention to investments in nonmarketable investment
participations:

	
			
	

	
			
	

	
			
	

8

Table of Contents
		
	E. 	NASD
AFFILIATION

		
	1. 	If you are a
corporation, the following questions should also be answered with
respect to your officers, directors and holders of 5% or more of
your equity securities; if you are a partnership, such questions should
also be answered with respect to your general partners.

(a) Are you (i) a member of the NASD, (ii) an affiliate of
a member of the NASD, (iii)  a person associated with a member or
an associated person of a member of the NASD? If so, describe the
relationship.

	
			
	

	
			
	

	
			
	

If
you answered ‘‘yes’’ above, then in connection
with your direct or indirect affiliation or association with a member
of the NASD, please furnish the identity and address of such NASD
member.

	
			
	

	
			
	

	
			
	

				
	 			                                                                                
Name
of Subscriber
	 			                                                                                
Signature
	Date:
                        			                                                                                
Title
	

9

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