Document:

Exhibit 10.7

 Exhibit 10.7 
 SUBSCRIPTION AGREEMENT AND LETTER OF INVESTMENT INTENT 
 Union Street Acquisition Corp. 
 102 South Union Street 
 Alexandria, Virginia 22314 
 Attention: Mr. A. Clayton Perfall, Chief Executive Officer 
 Ladies and
Gentlemen: 
 By his or her signature on this Subscription Agreement and Letter of Investment Intent (the “Subscription Agreement”),
the undersigned (the “Subscriber”) hereby confirms Subscriber’s subscription to purchase three million one hundred and twenty-five thousand (3,125,000) shares of $0.0001 par value common stock (the “Shares”) of Union
Street Acquisition Corp., a Delaware corporation (the “Company”) from Union Street Capital Management, LLC (“USCM”), for the sum of $0.008 per share, a purchase price of $25,000.00, in the aggregate, in accordance with the
following terms. 
 1. Acknowledgements and Effective Date of Purchase. The Subscriber hereby acknowledges that the Subscriber has
tendered to the Company, in cash, the sum of Twenty-five Thousand Dollars ($25,000.00) in consideration for the acquisition of the Shares. Upon receipt of such consideration, the Company shall cause to be executed and delivered to the Subscriber the
Company’s certificate evidencing the issuance of three million one hundred and twenty-five thousand (3,125,000) Shares in the name of the Subscriber. Subscriber’s right to subscribe to the Shares shall vest on the date that the
Subscriber executes this Subscription Agreement. 
 2. Representations and Warranties; Indemnification. The Subscriber hereby confirms
that the following representations and warranties to the Company, and all statements and information set forth in Paragraphs 3 and 4 hereof, are true as of the date hereof, and the Subscriber agrees to indemnify, hold harmless and pay all judgments
of and claims against the Company from any liability or injury, including but not limited to, those arising under federal or state securities laws, incurred as a result of any misrepresentation or misstatement by Subscriber herein or any warranties
not performed by the Subscriber. 

 (a) The Subscriber is the sole and true party in interest and is not purchasing the Shares for the
benefit of any other person. 
 (b) The Subscriber has read and reviewed the Registration Statement on Form S-1 with respect to the
initial public offering of securities by the Company (as so amended, the “Registration Statement”). The Subscriber has also been given the opportunity to review the Company’s organizational documents, each as amended as of the date of
this Subscription Agreement, and other related documents. The Subscriber understands that all books, records and documents of the Company relating to this investment have been and remain available for inspection by the Subscriber upon reasonable
advance notice to the Company. The Subscriber confirms that all documents that it has requested have been made available, and that the Subscriber has been supplied with all of the additional information concerning this investment which Subscriber
has requested. In making the decision to purchase the Shares, the Subscriber has relied exclusively upon information provided in writing by the Company, or found in the books, records or documents of the Company, and the Subscriber has had the
opportunity to ask questions of and receive answers from persons authorized and acting on behalf of the Company to verify the accuracy and completeness of such information. 
 (c) The Subscriber has such knowledge and experience in financial and business matters that it is capable of evaluating the merits and risks of this
investment. 
 (d) The Subscriber is aware that an investment in the Shares is highly speculative and subject to substantial risks. The
Subscriber is capable of bearing the high degree of economic risk and burdens of this venture, including but not limited to, the possibility of a complete loss of all contributed capital, the lack of a public market and limited transferability of
the Shares, which may make liquidation of this investment impossible for the indefinite future. The financial condition of the Subscriber is such that it is under no present or contemplated future need to dispose of any portion of the Shares to
satisfy any existing or contemplated undertaking, need or indebtedness. 
  

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 (e) The offer to sell the Shares was directly communicated to the Subscriber in such a manner that the
Subscriber was able to ask questions of and receive answers from the Company or a person acting on its behalf concerning the terms and conditions of this transaction. At no time was the Subscriber presented with or solicited by or through any
leaflet, public promotional meeting, television advertisement or any other form of general solicitation or general advertising within the meaning of Rule 502(c) under the Securities Act of 1933, as amended (the “Act”), in connection and/or
concurrently with such communicated offer. 
 (f) The Shares are being acquired solely for the Subscriber’s own account for investment,
and are not being purchased with a view to resale, distribution, subdivision or fractionalization thereof. 
 (g) The Subscriber understands
that the Shares have not been registered under the Act, or any state securities laws, in reliance upon exemptions from registration for non-public offerings. The Subscriber understands that the Shares or any interest therein may not and shall not be
resold, pledged, assigned, hypothecated or otherwise disposed of by the Subscriber unless the Shares are subsequently registered under the Act and under appropriate state securities laws or unless the Company receives an opinion of counsel
satisfactory to it that an exemption from registration is available. The cost of such opinion of counsel satisfactory to the Company shall be borne by the Subscriber. The Subscriber further understands that the Shares are subject to restrictions,
terms and conditions set forth in the insider letter between the Company and the Subscriber (the “Insider Letter”) and that no transfer of such Shares may be made without full compliance with such provisions of the Insider Letter as
pertain to the transfer of Shares and that any transfer in violation thereof shall be void ab initio. The Subscriber agrees that the certificate(s) evidencing the Shares being purchased shall be stamped or otherwise imprinted with a
conspicuous legend in substantially the following form: 
 “The securities represented by this certificate may not be offered for sale,
sold or otherwise transferred, except pursuant to an effective registration statement under the 
  

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 Securities Act of 1933, as amended (the “Act”), or pursuant to an exemption from registration
under the Act, the availability of which is to be established to the satisfaction of the issuer.” 
 (h) The undersigned has been
informed of and understands the following: 
  

	 	(1)	Risks. There are substantial risks involved in an investment in the Company, including (without limitation) those risks disclosed in the Registration Statement;

  

	 	(2)	Restrictions. There are substantial restrictions on the transferability of the Shares (both at law and under the terms of the Insider Letter), and such Shares will not be,
and investors in the Company have no right, except as set forth herein, to require that the Shares be, registered under the Act; and 

  

	 	(3)	Piggy-Back Registration. If at any time on or after the date three months prior to the date that is one year following the expected date of the Company’s consummation of
an initial business combination, as contemplated in the Registration Statement, the Company proposes to file a registration statement under the Act with respect to an offering of equity securities, or securities or other obligations exercisable or
exchangeable for, or convertible into, equity securities, by the Company for its own account (including, without limitation, pursuant to any demand for a registration by any holder of a registrable securities pursuant to the terms of any
registration rights agreement to which the Company and such holder may be parties (a “registration rights agreement”)), other than a Registration Statement (i) filed in connection with any employee stock option or other benefit plan,
(ii) for an exchange offer or offering of securities solely to the Company’s existing stockholders, (iii) for an offering of debt that is convertible into 

  

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	 	    	equity securities of the Company or (iv) for a dividend reinvestment plan, then the Company shall offer to the Subscriber the opportunity to register the sale of such number of
Shares as the Subscriber may request in writing within five (5) days following receipt of such offer, subject to the terms and conditions set forth in any registration rights agreement. The Company shall use its best efforts to cause the Shares
requested by the Subscriber to be included in such registration; provided, that, the Company shall have the right to postpone or withdraw any registration effected pursuant to this Section (3) without obligation to the Subscriber.

  

	 	(4)	No federal or state agency has made any finding or determination as to the fairness for private or public investment, or any recommendation or endorsement, of the Shares.

 (i) No broker, the Company, or any agent or employee of the Company or any other person has ever represented, guaranteed or
warranted to the Subscriber, expressly or by implication, the percentage of profit and/or amount of or type of consideration, profit or loss to be realized, if any, as a result of an investment in the Company. 
 3. Regulation D Matters. 
 (a) The
Subscriber is an “Accredited Investor” as such term is defined in Rule 501(a) of Regulation D promulgated under the Act. Subscriber qualifies as an Accredited Investor as a result of being an entity in which all of the equity owners
are accredited investors: 
 (b) The Subscriber certifies as to the accuracy and completeness of the following information: 
  

	

							
	Subscriber’s Business Address:	 		 	102 South Union Street , Alexandria, VA 22314	 	
				
		 		 	  
	 	

  

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 4. Tax Matters. 
 (a) Subscriber’s federal employer identification
number:                                       
                         . 
 (b) Subscriber certifies below, under penalties of perjury, whether Subscriber is a nonresident alien (as such term is used in the Code and the regulations promulgated thereunder) as indicated by checking one of the
following: 
              Subscriber is such a foreign person 

             Subscriber is not such a foreign person 
 (c) Subscriber’s complete address in country of permanent residence for income tax purposes: 
 102 South Union Street , Alexandria, VA 22314, USA 
 Note:
The above certification generally will remain in effect for three calendar years or until the Subscriber’s information changes. To avoid backup withholding, a foreign Subscriber should provide a new Form W-8 whenever the foreign
Subscriber’s information changes and at the end of three calendar years. 
 (d) Backup withholding certification (check one):

              Subscriber is subject to backup withholding. 
              Subscriber certifies, under penalties of perjury, that Subscriber is not
subject to backup withholding because: (i) Subscriber is exempt from backup withholding, or (ii) Subscriber has not been notified by the Internal Revenue Service that Subscriber is subject to backup withholding as a result of a failure to
report all interest or dividends, or (iii) the Internal Revenue Service has notified Subscriber that Subscriber is no longer subject to backup withholding. 
 5. Transferability. The Subscriber agrees not to transfer or assign the obligations or duties contained in this Subscription Agreement, or any of the Subscriber’s interest herein. 
  

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 6. Rule 501(e). Notwithstanding anything herein to the contrary, every person or entity who, in
addition to or in lieu of the Subscriber, is deemed to be a “purchaser” pursuant to Rule 501(e) promulgated under the Act does hereby make and join in making all of the covenants, representation and warranties made by the Subscriber.

 7. Acceptance. Execution and delivery of this Subscription Agreement and tender of the payment referenced in Paragraph 1 above
shall constitute an irrevocable offer to purchase the Shares, which offer may be accepted or rejected, in whole or in part, by the Company in its sole discretion, for any cause or for no cause. Acceptance of this offer by the Company shall be
indicated by the execution of this Subscription Agreement by the Company. 
 8. Binding Agreement. The Subscriber agrees that it may
not cancel, terminate or revoke this Subscription Agreement or any agreement of the Subscriber made hereunder, and that this Subscription Agreement shall survive the death or disability of the Subscriber, and shall be binding upon the heirs,
successors, executors, administrators, guardians, conservators or personal representatives of the Subscriber. 
 9. Notices. Any
notices or other communication required or permitted hereby shall be sufficiently given if sent by United States mail, postage prepaid and addressed, if to the Subscriber, at the address set forth under the Subscriber’s name below, and if to
the Company, at its address set forth on the first page of this Subscription Agreement, or otherwise to such address as either the Subscriber or the Company designates to the other in writing. 
 10. Applicable Law. This Subscription Agreement shall be governed by and construed in accordance with the laws of the State of Delaware and, to
the extent it involves any statute of the United States or rule thereunder, in accordance with the laws of the United States. 
 [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK.] 
  

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 IN WITNESS WHEREOF, the Subscriber has executed this Subscription Agreement on the date set forth
opposite the Subscriber’s signature below. 
 The exact spelling of the name under which the Shares shall be taken is Union Street
Capital Management, LLC. 
  

							
	Union Street Capital Management, LLC	 		 	
				
	By:	 	  
	 		 	Date:                          ,
2006
	Name:	 		 		 	
	Title:	 		 		 	
	Address:	 		 		 	

  

							
	Acknowledged by:	 		 	
			
	Union Street Acquisition Corp.	 		 	
				
	By:	 	  
	 		 	Date: July 24, 2006
	Name:	 		 		 	
	Title:      	 		 		 	

  

 - 8 -Exhibit 10.8

 Exhibit 10.8 
 FORM OF INSIDER LETTER 
 [            ],
2006 
 UNION STREET ACQUISITION CORP. 
 102 South Union Street 
 Alexandria, Virginia 22314 
 BANC OF AMERICA SECURITIES, LLC 
 9 West 57th Street 
 New York, New York 10019 
 MORGAN JOSEPH & CO., INC. 
 600 Fifth Avenue, 19th Floor

 New York, New York 10020 
 Re:  UNION STREET ACQUISITION CORP. 
 Gentlemen: 
 This letter is being delivered to you in accordance with (i) the Underwriting Agreement (the “Underwriting Agreement”) entered into by and
between Union Street Acquisition Corp., a Delaware corporation (the “Company”), and Banc of America Securities LLC and Morgan Joseph & Co., Inc., as representatives (the “Representatives”) of the underwriters named
therein, relating to an underwritten initial public offering (the “IPO”) of the Company’s units (the “Units’), each comprised of one share of the Company’s common stock, par value $0.0001 per share (the “Common
Stock”), and one warrant (a “Warrant”) exercisable for one share of Common Stock and (ii) the Purchase Agreement (the “Purchase Agreement”) entered into by and between the undersigned and Union Street Capital
Management, LLC (“USCM”) relating to the shares of the Common Stock (the “Private Placement Shares”) purchased by the undersigned in a private placement. Any capitalized terms not defined herein shall have the meaning ascribed to
such terms in the Company’s registration statement on Form S-1 (the “Registration Statement”) in connection with its IPO. 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 2 
 In order to induce the Company and the Underwriters to enter into the Underwriting Agreement and the Company to enter into the Purchase Agreement and to proceed with the IPO, and in recognition of the benefit that such IPO will confer upon
the undersigned as a stockholder of the Company, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the undersigned hereby agrees with the Company, USCM and the Representatives as follows:

 Undertakings as Stockholder 
 1. If the Company solicits approval of its stockholders of a Business Combination, the undersigned shall vote all Private Placement Shares owned by such person either for or against such Business Combination in the
same manner as the majority of the shares of common stock are voted by holders of the IPO Shares and shall vote all shares that may be acquired by such person in the IPO or in the aftermarket in favor of the Business Combination. 
 2. In the event that the Company fails to consummate a Business Combination within 18 months from the effective date (“Effective Date”) of the
Registration Statement (or under the circumstances described in the prospectus relating to the IPO (the “Prospectus”), 24 months from the Effective Date, each such date being referred to herein as the “Termination Date”), the
undersigned will vote to (i) cause the Company to dissolve and liquidate and (ii) distribute the assets of the Trust Account to the holders of the IPO Shares as soon as reasonably practicable. 
 3. The undersigned hereby waives any and all right, title, interest or claim of any kind in or to any distribution of the Trust Account and any remaining
net assets of the Company as a result of such liquidation with respect to his Private Placement Shares (“Claim”) and hereby waives any Claim the undersigned may have in the future as a result of, or arising out of, any contracts or
agreements with the Company and will not seek recourse against the Trust Account for any reason whatsoever. The undersigned hereby 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 3 
 agrees
that he shall promptly reimburse the Trust Account for any distribution of amounts in the Trust Account received by the undersigned in respect of such person’s Private Placement Shares. 
 4. The undersigned will escrow all of his Private Placement Shares acquired prior to the IPO until one year after the Company’s consummation of a
Business Combination subject to the terms of a Stock Escrow Agreement which the Company will enter into with the undersigned and an escrow agent acceptable to the Company. 
 5. The undersigned hereby waives his right to exercise conversion rights with respect to any Private Placement Shares owned or to be owned by the
undersigned, directly or indirectly and agrees that he will not seek conversion with respect to such shares in connection with any vote to approve a Business Combination. 
 6. The undersigned hereby agrees to not propose, or vote in favor of, an amendment to the Company’s Certificate of Incorporation to extend the period of time in which the Company must consummate a Business
Combination prior to its liquidation. Should such a proposal be put before stockholders other than through actions by the undersigned, the undersigned hereby agrees to vote against such proposal. This paragraph may not be modified or amended under
any circumstances. 
 Undertakings as Officer or Director [The following section will be tailored to each individual
signatory] 
 7. The undersigned agrees to be [a director and/or an officer] of the Company (a “Director”/an
“Officer”). 
 8. The undersigned has full right and power, without violating any agreement by which he is bound, to enter into
this letter agreement and to serve as a Director or an Officer of the Company. 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 4 
 9. In the event that (i) the Company fails to consummate a Business Combination within 18 months from the Effective Date and there has been no extension of the period under the circumstances described in the Prospectus, or
(ii) the 18-month period has been extended under the circumstances described in the Prospectus, but as of the date [30] days prior to the termination of such 24-month period the Company has not consummated the proposed Business Combination,
then the undersigned shall (a) take all reasonable actions within his power to cause the Board of Directors to convene to adopt a plan of dissolution and liquidation (the “Dissolution Plan”)[, and] (b) [vote in favor of
recommending such Dissolution Plan for approval by the Company’s stockholders and (c)][for Directors] as soon as practicable cause the Company to prepare and file a proxy statement with the Securities and Exchange Commission setting out,
and calling for a vote by the Company’s stockholders in favor of, the Dissolution Plan. If the 18-month period has been extended and within the 90-day period prior to the expiration of the 24-month period the Board of Directors is requesting
stockholder approval of the proposed Business Combination, then the undersigned shall (a) take all reasonable actions within his power to cause the Board of Directors to convene to adopt a Dissolution Plan and (b) vote in favor of
recommending such Dissolution Plan for approval by the Company’s stockholders, should the stockholders fail to approve the proposed Business Combination. In addition, from and after the date when the Company’s stockholders approve the
Dissolution Plan, the undersigned will, in accordance with the Company’s amended and restated certificate of incorporation, take all action reasonably within the undersigned’s power to limit the Company’s activities to winding up its
affairs and to dissolving the Company and liquidating the Trust Account. 
 10. In order to minimize potential conflicts of interest which
may arise from multiple affiliations, the undersigned agrees to present to the Company for its consideration, prior to presentation to any other person or entity, any suitable opportunity to acquire an operating business in the business services
industry as defined in the Company’s Registration Statement for the IPO of the Company’s securities, until the earlier of the consummation by 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 5 
 the Company of
a Business Combination, the dissolution and liquidation of the Company or until such time as the undersigned ceases to be a Director or an Officer of the Company, subject to any pre-existing fiduciary and contractual obligations the undersigned
might have. 
 11. The undersigned acknowledges and agrees that the Company will not consummate any Business Combination which involves a
company which is affiliated with any of the Insiders unless the Company obtains an opinion from an independent investment banking firm reasonably acceptable to the Underwriters that the business combination is fair to the Company’s stockholders
from a financial perspective. 
 12. Neither the undersigned, any member of the family of the undersigned, nor any affiliate
(“Affiliate”) of the undersigned will be entitled to receive and will not accept any compensation for services rendered to the Company prior to or in connection with the consummation of the Business Combination; provided that commencing on
the Effective Date, USCM shall be allowed to charge the Company $7,500 per month, representing an allocable share of USCM’s overhead, to compensate it for the Company’s use of USCM’s offices, utilities and personnel. USCM and the
undersigned shall also be entitled to reimbursement from the Company for their out-of-pocket expenses incurred in connection with seeking and consummating a Business Combination. 
 13. Neither the undersigned, any member of the family of the undersigned, nor any Affiliate of the undersigned will be entitled to receive or accept a
finder’s fee or any other compensation in the event the undersigned, any member of the family of the undersigned or any Affiliate of the undersigned originates a Business Combination. 
 14. The undersigned agrees that during his period of service as a Director or an Officer, he will not become associated with any other special purpose
activity corporation that is involved or intends to become involved in any activities similar to those activities that the Company intends to pursue. 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 6 
 15. The undersigned represents and warrants that (i) biographical information furnished to the Company and the Underwriters and attached hereto as Exhibit A is true and accurate in all respects (other than de minimis errors or
omissions), does not omit any material information with respect to the undersigned’s background during the past five years and contains all of the information required to be disclosed pursuant to Item 401 of Regulation S-K, promulgated
under the Securities Act of 1933, as amended, and (ii) the questionnaire furnished by the undersigned to the Company and the Underwriters and annexed as Exhibit B hereto is true and accurate in all respects (other than de minimis errors
or omissions. The undersigned further represents and warrants that: 
 (a) he is not subject to, or a respondent in, any legal
action for, any injunction, cease-and-desist order or order or stipulation to desist or refrain from any act or practice relating to the offering of securities in any jurisdiction; 
 (b) he has never been convicted of or pleaded guilty to any crime (i) involving any fraud, or (ii) relating to any financial
transaction or handling of funds of another person, or (iii) pertaining to any dealings in any securities and he is not currently a defendant in any such criminal proceeding; 
 (c) he has never been suspended or expelled from membership in any securities or commodities exchange or association or had a securities
or commodities license or registration denied, suspended or revoked; and 
 (d) the undersigned consents to being named in the
Registration Statement as a member of the Board of Directors or an Officer of the Company. 
 16. The undersigned understands that the
Underwriters and their legal representatives or agents (the “Agents”) may conduct a reasonable background check with 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 7 
 respect to the
undersigned and neither the Underwriters or the Agents shall be violating the undersigned’s right of privacy in any manner in requesting and obtaining such information, and the undersigned releases them from liability for any damage whatsoever
in connection with requesting and obtaining such information; provided, that the Underwriters and the Agents shall maintain the confidentiality of any information received pursuant thereto, and further shall not transfer, or cause or permit the
transfer of, such information to any other person or party, or use such information other than in connection with the IPO, in each case without the express written consent of the undersigned. 
 17. The undersigned authorizes any employer, financial institution, or consumer credit reporting agency to release to the Underwriters and their legal
representatives or agents (including any investigative search firm retained by the Underwriters) any information they may have about the undersigned’s background and finances (“Information”). 
 [Undertakings of Clay Perfall and Brian Burke only] 
 18. The undersigned, as the [            ] of the Company, agrees that in the event that the Company is dissolved and liquidated to be personally
liable for ensuring that the proceeds in the Trust Account are not reduced by the claims of vendors for services rendered or products sold to the Company in each case to the extent that the payment of any such debts or obligations would actually
reduce the amount in the Trust Account; provided that the undersigned will not have any personal liability as to any claimed amounts owed to a third party who has executed a waiver to rights or claims to the Trust Account, the underwriters or any
prospective target business. 
 General Undertakings 
 19. This letter agreement shall be governed by and construed and enforced in accordance with the laws of the State of New York, without regard to the
conflicts of law principles to the extent such principles and rules would require or permit the application of the substantive laws of another jurisdiction. This letter agreement shall be binding on the undersigned. 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 8 
 20. This letter agreement shall terminate on the earlier of (i) of the Business Combination date and (ii) [            ]. 
 21. No term or provision of this letter agreement may be amended, changed, waived, altered or modified except by written instrument executed and
delivered by the party against whom such amendment, change, waiver, alteration or modification is to be enforced. 
 22. As used herein,
(i) a “Business Combination” shall mean an acquisition through a merger, capital stock exchange, stock purchase, asset acquisition, or other similar business combination of one or more operating businesses in the business services
industry; (ii) “Insiders” shall mean all officers, directors and stockholders of the Company immediately prior to the IPO; (iii) “IPO Shares” shall mean the shares of Common Stock issued in the Company’s IPO; and
(iv) “Trust Account” shall mean that certain trust account established with Continental Stock Transfer & Trust Company, as trustee, and in which the Company has deposited certain of the proceeds of the IPO as described in the
Prospectus. 
 [The Remainder of this Page is Intentionally Left Blank] 

 UNION STREET ACQUISITION CORP. 
 BANC OF AMERICA SECURITIES, LLC 
 MORGAN JOSEPH & CO., INC. 
 October
    , 2006 
 Page 9 
  

	
	Print Name of Insider
	
	 /s/

	Signature

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