Document:

cogo_s8-ex0412.htm

    
      

    

    Exhibit 4.12

     

    COGO
GROUP, INC.

    2009
OMNIBUS SECURITIES AND INCENTIVE PLAN

    STOCK
OPTION AGREEMENT

    DIRECTOR
NON-QUALIFIED STOCK OPTION

     

    THIS
AGREEMENT made as of ________________, 200_, by and between Cogo Group, Inc., a
Maryland corporation (the “Company”), and
______________ (the “Optionee”).

     

    WITNESSETH:

     

    WHEREAS,
the Company has adopted the Cogo Group, Inc. 2009 Omnibus Securities and
Incentive Plan (the “Plan”) for the
benefit of its employees, nonemployee directors and consultants and the
employees, nonemployee directors and consultants of its affiliates,
and

     

    WHEREAS,
the Committee has authorized the grant to the Optionee of an Option under the
Plan, on the terms and conditions set forth in the Plan and as hereinafter
provided,

     

    NOW,
THEREFORE, in consideration of the premises contained herein, the Company and
the Optionee hereby agree as follows:

     

    1.   Definitions.

     

    Terms
used in this Agreement which are defined in the Plan shall have the same meaning
as set forth in the Plan.

     

    2.   Grant of
Option.

     

    The
Committee hereby grants to the Optionee an option to purchase [insert # of shares] shares of the
Company’s Common Stock (“Shares”) for an
Option price per Share equal to [insert price] (not less than
the Fair Market Value of a Share on the date of the grant of the Option) (the
“Option”).

     

    3.   Option Terms and Exercise
Period.

     

    (a)  The
Option shall be exercised, and payment by the Optionee of the Option price shall
be made, pursuant to the terms of the Plan.

     

    (b)  All or
any part of the Option may be
exercised by the Optionee no later than the tenth (10th) anniversary of the
date of this Agreement.

     

    (c)  This
Agreement and the Option shall terminate on the earlier of (i) the tenth (10th)
anniversary of the date of this Agreement or (ii) the date the Option is fully
exercised.

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    4.   Vesting.

     

    [Subject to Section 10,] the Option shall vest and
become exercisable pursuant to the following schedule:

     

     

    Insert
Vesting Schedule

     

     

    5.   Termination of Director
Status.

     

    [Sections 6.2 and 6.4 of the
Plan shall control.]

     

    6.   Restrictions on Transfer of
Option.

     

    This
Agreement and the Option shall not be transferable otherwise than (a) by will or
by the laws of descent and distribution or (b) by gift to any Family Member of
the Optionee, and the Option shall be exercisable, during the Optionee’s
lifetime, solely by the Optionee, except on account of the Optionee’s Permanent
and Total Disability or death, and solely by the transferee in the case of a
transfer by gift to a Family Member of the Optionee.

     

    7.   Exercise of
Option.

     

    (a)  The
Option shall become exercisable at such time as shall be provided herein or in
the Plan and shall be exercisable by written notice of such exercise, in the
form prescribed by the Committee, to the Secretary of the Company, at its
principal office. The notice shall specify the number of Shares for which the
Option is being exercised.

     

    (b)  Shares
purchased pursuant to the Option shall be paid for in full at the time of such
purchase in cash, in Shares, including Shares acquired pursuant to the Plan, or
part in cash and part in Shares. Shares transferred in payment of the Option
price shall be valued as of the date of transfer based on their Fair Market
Value.

     

    8.   Regulation by the
Committee.

     

    This
Agreement and the Option shall be subject to any administrative procedures and
rules as the Committee shall adopt. All decisions of the Committee upon any
question arising under the Plan or under this Agreement, shall be conclusive and
binding upon the Optionee and any person or persons to whom any portion of the
Option has been transferred by will, by the laws of descent and distribution or
by gift to a Family Member of the Optionee.

     

    9.   Rights as a
Stockholder.

     

    The
Optionee shall have no rights as a stockholder with respect to Shares subject to
the Option until certificates for Shares of Common Stock are issued to the
Optionee.

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    10.   [Change of
Control.

     

    Notwithstanding
the vesting requirements contained in Section 4, upon a Change  of
Control, the Option shall automatically become fully vested and exercisable as
of the date of such Change of Control.]

     

    11.   Reservation of
Shares.

     

    With
respect to the Option, the Company hereby agrees to at all times reserve for
issuance and/or delivery upon payment by the Optionee of the Option price, such
number of Shares as shall be required for issuance and/or delivery upon such
payment pursuant to the Option.

     

    12.   Delivery of Share
Certificates.

     

    Within a
reasonable time after the exercise of the Option the Company shall cause to be
delivered to the Optionee, his or her legal representative or his or her
beneficiary, a certificate for the Shares purchased pursuant to the exercise of
the Option.

     

    13.   Amendment.

     

    The
Committee may amend this Agreement at any time and from time to time; provided, however, that no
amendment of this Agreement that would materially and adversely impair the
Optionee’s rights or entitlements with respect to the Option shall be effective
without the prior written consent of the Optionee.

     

    14.   Plan
Terms.

     

    The terms
of the Plan are hereby incorporated herein by reference.

     

    15.   Effective Date of
Grant.

     

    The
Option shall be effective as of the date first written above.

     

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    16.   Optionee
Acknowledgment.

     

    By
executing this Agreement, the Optionee hereby acknowledges that he or she has
received and read the Plan and this Agreement and that he or she agrees to be
bound by all of the terms of both the Plan and this Agreement.

     

    

    
      	
              ATTEST:

            	 
      	
              COGO
      GROUP, INC.

            
	 
      	 
      	 
      
	
              ________________________________

            	 
      	
              By:_________________________________                                 

               

              Its:_________________________________

               

              ____________________________,
      Optioneemont1012ga12310ex10_1.htm

    
      
EXHIBIT 10.1

     

    
      Investor: _________________

      

      

      MINT
CAPITAL, INC.

      

      

      SUBSCRIPTION
AGREEMENT

      

      

      

      In order
to subscribe for shares of Common Stock, par value $.001 per share, of Mint Capital, Inc. a Florida
corporation (the “Company”), a prospective
investor must complete and execute the subscription documents contained in this
booklet in accordance with the instructions set forth herein. Upon completion
and execution of these documents, this entire booklet, together with the
appropriate payment described herein either by check or wire transfer, pursuant
to the instructions attached, should be returned to:

      

      Mint
Capital, Inc

      319
Clematis Street, Suite 703

      West Palm
Beach FL. 33401

      Telephone:
(561) 514-9042

      

      Subscriptions
from suitable prospective investors will be accepted at the sole discretion of
the Company after receipt of all subscription documents, properly completed and
executed, with the appropriate payment.  If your subscription is not
accepted, your original documents and payments will be returned to you without
interest.

      

      Please be
sure your name appears exactly the same way in each signature and in each place
where it is marked in the documents.

      

      If you
have any questions concerning completion of these subscription documents, please
contact Barry Hollander, Incorporator of the Company, at (561)
514-9042.

      

      ALL
INVESTORS MUST COMPLETE PAGES 1-5 OF THESE SUBSCRIPTION DOCUMENTS, ALONG WITH
THE APPLICABLE INVESTOR QUALIFICATION QUESTIONNAIRE APPLICABLE TO THE TYPE OF
INVESTOR SET FORTH BELOW.

      

      THE
SECURITIES BEING OFFERED BY MINT CAPITAL, INC. HEREUNDER HAVE NOT BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933 OR APPLICABLE STATE BLUE SKY OR
SECURITIES LAWS AND ARE OFFERED UNDER AN EXEMPTION PROM THE REGISTRATION
PROVISIONS OF SUCH LAWS.

      

      THESE
SECURITIES CANNOT HE SOLD, TRANSFERRED, ASSIGNED OR OTHERWISE DISPOSED OF EXCEPT
IN COMPLIANCE WITH THE RESTRICTIONS ON TRANSFER CONTAINED IN THIS STOCK
SUBSCRIPTION AGREEMENT AND APPLICABLE FEDERAL AND STATE SECURITIES
LAWS.

       

      
        
           

        

        
           

          
            

          

        

        
           

        

      

       

      ALL
INVESTORS MUST READ PAGES 1-4

      AND
COMPLETE AND SIGN THE SIGNATURE PAGE (PAGE 5)

      

      SUBSCRIPTION
APPLICATION

      AND
SIGNATURE PAGE

      

      

      

      

      Mint
Capital, Inc.

      319
Clematis Street, Suite 703

      West Palm
Beach FL.  33401

      

      

      Ladies
and Gentlemen:

      

      The undersigned hereby subscribes for
and agrees to purchase the number of shares of Common Stock (the “Shares”) of Mint Capital, Inc., a Florida
corporation (the “Company” or “MINT”), set forth
on the signature page to this Subscription Application, at a purchase price
equal to $0.001 per Share and upon the terms and conditions set forth below.
There is no minimum aggregate subscription amount required under this offering
(the “Offering”), and
all funds received in connection with the sale of the Shares hereunder will be
immediately available to be held and used by the Company for general corporate
purposes.

      

      
        	
                1.  

              	
                General Investor
      Representations and Warranties.  By executing this
      Subscription Application, the undersigned acknowledges, warrants, and
      represents as follows:

              

      

      

      
        	
                a.  

              	
                The
      undersigned understands that the Company is a newly created startup
      company that was recently formed, has conducted no business operations
      other than organizational activities.  The Company has no full
      time employees and owns no real estate or personal
      property.  The Company was formed as a vehicle to pursue a
      business combination and has made no efforts to identify any possible
      business combination.  The Company has not conducted
      negotiations or entered into a letter of intent concerning any target
      business.  The purpose of the business is to seek the
      acquisition or merger with, an existing company. The undersigned further
      understands that no shares of the Company’s capital stock including the
      shares to be sold herein have been registered under the Securities Act of
      1933, as amended (the “Act”), and there
      currently is no market for the Company’s common
  stock.

              

      

      

      
        	
                b.  

              	
                The
      undersigned has, either alone or with the assistance of a professional
      advisor, sufficient knowledge and experience in financial and business
      matters that the undersigned believes himself/herself capable of
      evaluating the merits and risks of the prospective investment in the
      Shares and the suitability of an investment in the Shares in light of the
      undersigned’s financial condition and investment needs, and legal, tax and
      accounting matters.

              

      

      

      
        	
                c.  

              	
                The
      undersigned has been given access to full and complete information
      regarding the Company and has utilized such access to the undersigned’s
      satisfaction for the purpose of obtaining information. Particularly, the
      undersigned has been given reasonable opportunity to meet with Company
      representatives for the purpose of asking questions of, and receiving
      answers from, such representatives concerning the terms and conditions of
      the Offering and to obtain any additional information, to the extent
      reasonably available, necessary to verify the accuracy of information
      contained herein.

              

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
        	
                d.  

              	
                The
      undersigned is an “accredited investor” as defined in Rule 501(a) of
      Regulation D promulgated under the Act.  This representation is
      based on the information provided by the undersigned and set forth on the
      Investor Qualification Questionnaire attached
  hereto.

              

      

      

      
        	
                e.  

              	
                The
      undersigned recognizes that an investment in the Shares involves a high
      degree of risk, including, but not limited to, the risk of losing
      his/her/its entire investment.

              

      

      

      
        	
                f.  

              	
                No
      federal or state agency, including the United States Securities and
      Exchange Commission or the securities commission or authority of any
      state, has approved or disapproved the Shares, passed upon or endorsed the
      merits of the Offering of the Shares or the accuracy or adequacy of the
      Disclosure Documents, or made any finding or determination as to fairness
      of the Shares for public sale.

              

      

      

      
        	
                g.  

              	
                The
      undersigned has been encouraged to rely upon the advice of the
      undersigned’s legal counsel and accountants or other financial advisors
      with respect to tax and other considerations relating to the purchase of
      Shares.  The undersigned is not relying upon the Company with
      respect to the economic considerations involved in determining to make an
      investment in the Shares.

              

      

      

      
        	
                2.  

              	
                Investment Purpose of
      Subscriber.  The undersigned represents and warrants that
      it is the undersigned’s intention to acquire the Shares for the account of
      the undersigned and for investment purposes and not with a view to resell
      the Shares in connection with any distribution thereof.  In
      order to assure the Company that the undersigned has no present intention
      to resell or dispose of the Shares, the undersigned further represents and
      warrants the following facts:

              

      

      

      
        	
                a.  

              	
                The
      undersigned intends to receive and hold the Shares for the undersigned’s
      personal account.

              

      

      

      
        	
                b.  

              	
                The
      undersigned has no contract, undertaking, agreement or arrangement with
      any person or entity to sell or transfer the Shares to any such person or
      entity or to have any such person or entity sell the Shares on behalf of
      the undersigned.

              

      

      

      
        	
                c.  

              	
                The
      undersigned has no need for immediate liquidity with respect to
      his/her/its investments and has sufficient income to meet the
      undersigned’s current and anticipated obligations.  The loss of
      the undersigned’s entire investment in the Shares would not cause
      financial hardship to the undersigned and would not adversely affect the
      undersigned’s current standard of living.  In addition, the
      overall commitment of the undersigned to investments that are not readily
      marketable is not disproportionate to the undersigned’s net worth and the
      undersigned’s investment in the Shares will not cause such overall
      commitment to become excessive.

              

      

      

      
        	
                d.  

              	
                The
      undersigned is not aware of any occurrence, event, or circumstance upon
      the happening of which the undersigned intends to transfer or sell the
      Shares and the undersigned does not have any present intention to transfer
      or sell the Shares after a lapse of any particular period of
      time.

              

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
        	
                e.  

              	
                The
      undersigned has been informed that in the view of the certain state
      securities commissions, a purchase of Shares with a current intent to
      resell, by reason of any foreseeable specific contingency or anticipated
      change in market values, any change in the condition of the Company or the
      Company’s industry, or in connection with a contemplated liquidation or
      settlement of any loan obtained for the acquisition of the Shares, would
      represent a purchase with an intent inconsistent with the representations
      set forth above, and that certain state securities commissions, might
      regard such sale or disposition as a deferred sale with regard to which an
      exemption from registration is not
available.

              

      

      

      
        	
                f.  

              	
                The
      undersigned represents and agrees that if, contrary to the foregoing
      representations and warranties, the undersigned should later desire to
      dispose of or transfer any of the Shares in any manner, the undersigned
      shall not do so without first obtaining (i) an opinion of counsel
      satisfactory to the Company that such proposed disposition or transfer may
      be made lawfully without the registration of the Shares pursuant to the
      Act and applicable state laws, or (ii) registration of such
      Shares.

              

      

      

      
        	
                g.  

              	
                The
      undersigned, if other than an individual, represents and warrants that (i)
      it was not organized for the specific purpose of acquiring the Shares and
      (ii) this subscription has been duly authorized by all necessary action on
      the part of the undersigned, has been duly executed by an authorized
      officer or representative of the undersigned, and is a legal, valid and
      binding obligation of the undersigned enforceable in accordance with its
      terms.

              

      

      

      
        	
                3.  

              	
                Registration Status of Shares;
      Restrictions on Transferability.  The undersigned
      understands, acknowledges and agrees
that:

              

      

      

      
        	
                a.  

              	
                The
      Shares to be issued in connection with this subscription have not been
      registered under the Act or under applicable state securities acts on the
      grounds that the Shares are being issued in a transaction (i) involving a
      limited group of knowledgeable investors fully familiar with the affairs
      and proposed operations of the Company, and (ii) not involving a public
      offering and that, consequently, such transaction is exempt from
      registration under the Act and the state securities acts.  The
      Company will rely on the undersigned’s representations herein and in the
      Investor Qualification Questionnaire as a basis for the exemption from
      registration.

              

      

      

      
        	
                b.  

              	
                The
      Shares may not be sold, transferred or otherwise disposed of except
      pursuant to an effective registration statement or appropriate exemption
      from registration under applicable state law and, as a result, the
      undersigned must comply with the transfer requirements set forth in
      Paragraph 3(f) above and may be required to hold the Shares for an
      indefinite period of time.

              

      

      

      
        	
                c.  

              	
                The
      Company is under no obligation to file a registration statement with
      respect to the Shares. Furthermore, the provisions of Rule 144 under the
      Act will permit resale of the Shares only under limited
      circumstances.  For example, the Shares must be held by the
      undersigned for at least one year before they can be sold pursuant to Rule
      144 and even then such sales will be further restricted by certain volume
      limitations.

              

      

      

      
        	
                4.  

              	
                Legend on Certificates to be
      Issued. The undersigned understands and acknowledges that the stock
      certificate representing the Shares subscribed for hereby and to be issued
      by the Company upon acceptance of this Subscription Application will
      contain substantially the following
legends:

              

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      THE
SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (the “Act”), OR APPLICABLE STATE SECURITIES
LAWS.  NO SALE OR ASSIGNMENT OF THE SHARES REPRESENTED BY THIS
CERTIFICATE SHALL BE MADE EXCEPT IN CONJUNCTION WITH AN EFFECTIVE REGISTRATION
STATEMENT FOR THE SECURITIES UNDER APPLICABLE SECURITIES LAWS UNLESS THE HOLDER
SHALL HAVE OBTAINED AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH
PROPOSED DISPOSITION OR TRANSFER LAWFULLY MAY BE MADE WITHOUT REGISTRATION OF
SUCH SHARES PURSUANT TO APPLICABLE SECURITIES LAWS, OR SUCH
REGISTRATION.

      

      
        	
                5.  

              	
                Binding
      Effect.  Upon acceptance by the Company, this
      Subscription Application shall be binding upon and shall inure to the
      benefit of the Company and the undersigned and to the successors and
      assigns of the Company and to the personal and legal representatives,
      heirs, guardians, successors, and permitted assignees of the
      undersigned.

              

      

      

      
        	
                6.  

              	
                Further Acts and
      Assurances. Upon request, the undersigned agrees to furnish to the
      Company such additional information as may be deemed necessary to
      determine the undersigned’s suitability as an
  investor.

              

      

      

      

      [The
remainder of this page is intentionally left blank.]

      

      

       
 

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      

      INVESTOR
SIGNATURE PAGE

      

      

      THE UNDERSIGNED IS SUBSCRIBING FOR THE
NUMBER OF SHARES SET FORTH BELOW PURSUANT TO THIS SUBSCRIPTION APPLICATION AND
IS DELIVERING HEREWITH AN AMOUNT EQUAL TO THE AGGREGATE PURCHASE PRICE SET FORTH
BELOW.

      

      

      

      

      

      Number of Shares

      

      $
0.001                                                                           

      Purchase
Price/Share                                                                Aggregate
Purchase Price

      

      

      

      

      Date
Signed                                                      Signature
of
Investor                                                      (Additional
signature if required)

      

      

      PRINT Name of Individual, Corporation,
Partnership, Plan or Trust

      

      

      Social Security No. or Federal Tax
I.D. No. under which Shares shall be registered

      

      

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      

      INDIVIDUAL
INVESTOR QUALIFICATION QUESTIONNAIRE

      (Individual Investors Must
Complete This Page)

      

      

      1.           GENERAL
INFORMATION FOR INDIVIDUAL INVESTORS.

      

      Check One:

      

      
        	
                ð  

              	
                Individual
      Ownership

              

      

      
        	
                ð  

              	
                Joint
      tenants with right of survivorship*

              

      

      
        	
                ð  

              	
                Community
      property*

              

      

      
        	
                ð  

              	
                Tenants
      in common*

              

      

      
        	
                ð  

              	
                Individual
      ownership pursuant to purchases under the Uniform Gift to minors
      Acts**

              

      

      
        	
                ð  

              	
                Other:

              

      

      

      
        	
                 
      

              	 

      

      

      

      Name of
Beneficiary under Uniform Gift to Minors Act    Social Security No.
of  Beneficiary

      

      

      *
Signatures of all parties required.  Each Co-Investor (other than a
spouse) must complete and sign a separate Subscription Application and Investor
Qualification Questionnaire.

      

      ** All
information requested in connection with investments under the Uniform Gift to
Minors Act should be given on behalf of the adult custodian, not the minor
beneficiary.

      

      

      

      

      PLEASE
PRINT THE EXACT NAME(S) UNDER WHICH YOUR SHARES ARE TO BE
REGISTERED:

      

      

      

      State of
Principal Residence:

      

      

      

      Home
Address:

      

      

      (Address
-- No P.O. Boxes please)

      

      City:                                              State:                         Zip
Code: 

      

      Address
where you want our mail sent if different than above:

      

      

      (Address
-- No P.O. Boxes please)

      

      City:                                              State:                         Zip
Code: 

      

      

      Home
Telephone
Number:                                                        (          ) 

      

      Business
Telephone
Number:                                                        (          ) 

      

      Facsimile
Number:                                             (          ) 

      

      Email
Address:                                           

      

      

      2.           ACCREDITED
INVESTOR STATUS.

      

      2.1           Accredited
Investor Status:  Please complete each of the following
certifications:

      

      
        	
                 
      

              	
                (a)

              	
                I
      certify that I have an individual net worth (or a joint net worth with my
      spouse) in excess of $1,000,000 (including without limitation homes, home
      furnishings and automobiles).

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                (b)

              	
                I
      certify that I had individual income (excluding and income of my spouse)
      of more than $200,000 in each of the previous two calendar years or joint
      income with my spouse in excess of $300,000 in each of those years and I
      reasonably expect to reach the same income level in the current
      year.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                (c)

              	
                I
      certify that I am a director or executive officer of the
      Company

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      TRUST
INVESTOR QUALIFICATION QUESTIONNAIRE

      
        	
                 
      

              	
                (Trust Investors Must
      Complete This Page)

              

      

      

      

      
        	
                1.

              	
                TRUST
      INVESTORS

              

      

      

      
        	
                 
      

              	
                1.1

              	
                Name
      of Trust:

              	 

      

      

      
        	
                 
      

              	 

      

      

      
        	
                 
      

              	
                1.2

              	
                Trustee(s):

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Name

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Address

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Telephone
      Number

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Email
      Address

              

      

      

      
        	
                 
      

              	
                1.3

              	
                Date
      of Establishment:

              	 

      

      
        	
                 
      

              	
                1.4

              	
                State
      in which Settled:

              	 

      

      

      
        	
                 
      

              	
                1.5

              	
                Number
      of Beneficiaries:

              	 

      

      

      
        	
                 
      

              	
                1.6

              	
                Has
      the Trust been formed for the specific purpose of investing in
      Shares?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                1.7

              	
                Type
      of Trust:  (Check One)

              

      

      

      
        	
                o   Revocable

              	
                o   Irrevocable

              

      

      

      
        	
                 
      

              	
                Name
      of Grantor(s) (persons establishing the trust) of Revocable
      Trust:

              

      

      
 

      IF
THE TRUST IS REVOCABLE, DO NOT COMPLETE THE REMAINDER OF THIS TRUST INVESTOR
QUALIFICATION QUESTIONNAIRE AND HAVE EACH GRANTOR COMPLETE EXHIBIT
A.  IF THE TRUST IS IRREVOCABLE, COMLETE THE REMAINDER OF THIS TRUST
INVESTOR QUALIFICATION QUESTIONNAIRE.

      

       

      

      
        	
                2.

              	
                ACCREDITED INVESTOR
      STATUS.  Please complete each of the following
      certifications:

              

      

      

      
        	
                 
      

              	
                2.1

              	
                The
      undersigned Trust has as its trustee a bank as defined in Section 3(a)(2)
      of the Securities Act of 1933, as amended, or a savings and loan
      association or other institution as defined in Section 3(a)(5)(A) of the
      Securities Act of 1933, as amended.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.2

              	
                The
      undersigned Trust certifies that it has total assets in excess of
      $5,000,000, was not formed for the specific purpose of acquiring the
      Shares and is directed by a sophisticated person as defined in Rule
      506(b)(2)(ii) under the Securities Act of 1933, as amended (i.e., a person
      who has such knowledge and experience in financial and business matters
      that he or she is capable of evaluating the merits and risks of an
      investment in the Shares).

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      

      

      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      PLAN
INVESTOR QUALIFICATION QUESTIONNAIRE

      (IRA/Qualified
Pension, Profit Sharing or Stock/Keogh Investors Must Complete This
Page)

      

      

      

      1.           PLAN
INVESTORS

      

      1.1           Name
of Plan:

      

      

      

      
        	
                 
      

              	
                1.2
      (a)

              	
                Type
      of Plan:  o Qualified
      Pension, Profit Sharing or Stock Bonus Plan

              	
                o
    Keogh

              	
                o  IRA

              

      

      

      
        	
                 
      

              	
                o  Other
      (Specify):

              

      

      

      
        	
                 
      

              	
                1.2(b)

              	
                Plan
      Fiduciaries:

              

      

      

      
        	
                 
      

              	 

      

      Name

      

      

      Address

      

      

      Telephone Number

      

      

      Email Address

      

      1.3           Date
of Establishment:

      

      1.4           State
in which Organized:

      

      
        	
                 
      

              	
                1.5

              	
                Has
      the subscribing Plan been formed for the specific purpose of investing in
      Shares?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                1.6(a)

              	
                Does
      each Plan participant who will invest in Shares (i) have the power to
      direct his/her investments and (ii) intend to invest in Shares pursuant to
      the exercise of such power?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                1.6(b)

              	
                Does
      the Plan have one Plan participant or provide for segregated accounts for
      each Plan participant?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                1.6(c)

              	
                Does
      the undersigned Plan certify that investment decisions are made solely by
      persons that are accredited
investors?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      
 

      IF
THE PLAN ANSWERED YES TO BOTH QUESTIONS 1.6(a) AND 1.6(b) ABOVE OR TO QUESTION
1.6(c) ABOVE, THEN

      

      
        	
                 
      

              	
                (a)

              	
                (i)  List
      Number of Plan participants:

              	 

      

      

      
        	
                 
      

              	
                (ii)  Name
      participant(s) who will invest in
Shares:

              

      

      

      
        	
                 
      

              	
                Name

              	
                Address

              	
                Telephone
      No.

              

      

      

      
 

      
        	
                and
      (b):

              	
                EACH PLAN PARTICIPANT INVESTING
      IN SHARES SHOULD COMPLETE EXHIBIT A, AND THE PLAN SHOULD NOT COMPLETE
      SECTION 2 BELOW.

              

      

      

      IF
THE PLAN DID NOT ANSWER YES TO BOTH QUESTIONS 1.6(a) AND 1.6(b) ABOVE OR TO
QUESTION 1.6(c) ABOVE, THEN THE PLAN MUST COMPLETE SECTION 2.

      

      2.           ACCREDITED INVESTOR
STATUS.

      

      
        	
                 
      

              	
                2.1

              	
                The
      undersigned Plan certifies that it is an employee benefit plan within the
      meaning of Title I of the Employee Retirement Income Security Act of 1974
      (“ERISA”) and either (i) has total assets in excess of $5,000,000, (ii)
      has its investment decisions made by a fiduciary, as defined in Section
      3(21) of ERISA, which is either a bank, savings and loan association,
      insurance company or registered investment adviser, or (iii) is a
      self-directed plan with investment decisions made solely by persons that
      are “accredited investors” as defined by Rule 501(a) of the Securities Act
      of 1933, as amended.

              

      

      

      o   Yes                                o   No

      

      
        	
                 
      

              	
                2.2

              	
                The
      undersigned Plan certifies that it is a plan established and maintained by
      a state, its political subdivisions, or any agency or instrumentality of a
      state or its political subdivisions, for the benefit of its employees and
      such plan has assets in excess of
$5,000,000.

              

      

      

      o   Yes                                o   No

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      CORPORATE,
PARTNERSHIP, OR LIMITED LIABILITY COMPANY INVESTOR QUALIFICATION
QUESTIONNAIRE

      (Corporate,
Partnership, or Limited Liability Company Investors Must Complete This
Page)

      

      

      
        	
                1.

              	
                GENERAL
      INFORMATION FOR CORPORATE, PARTNERSHIP OR LLC
  INVESTORS

              

      

      

      
        	
                 
      

              	
                1.1

              	
                Name
      of Corporation, Partnership or LLC:

              

      

      

      
        	
                 
      

              	 

      

      

      
        	
                 
      

              	
                1.2

              	
                Date
      of Formation:

              	 

      

      

      
        	
                 
      

              	
                1.3

              	
                State
      of Incorporation/Organization:

              	 

      

      

      
        	
                 
      

              	
                1.4

              	
                Type
      of Organization:

              	 

      

      

      
        	
                 
      

              	
                1.5

              	
                Has
      the subscribing entity been formed for the specific purpose of investing
      in Shares?

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Address

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Telephone
      Number

              

      

      

      
        	
                 
      

              	 

      

      
        	
                 
      

              	
                Email
      Address

              

      

      

      
        	
                2.

              	
                ACCREDITED
      INVESTOR STATUS.

              

      

      

      Please
complete each of the following certification:

      

      
        	
                 
      

              	
                2.1

              	
                The
      undersigned Investor certifies that EACH one of its equity holders meets
      at least one of the following conditions set forth in statement 2.1(i),
      (ii) or (iii) below.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                (a)

              	
                Such
      equity holder is a natural person whose individual net worth (or joint net
      worth his/her spouse) exceeds
$1,000,000.

              

      

      

      
        	
                 
      

              	
                (b)

              	
                Such
      equity holder is a natural person who had an individual income in excess
      of $200,000 in each of the previous two calendar years or joint income
      with such person’s spouse in excess of $300,000 in each of those years and
      who reasonably expects to reach the same income level for the current
      calendar year.

              

      

      

      
        	
                 
      

              	
                 (c)

              	
                Such
      equity holder is an entity and all of the equity holders, respectively, of
      such entity can answer yes to statement 2.1(i) of 2.1(ii) above or is
      otherwise an “accredited investor” as defined by Rule 501(a) of the
      Securities Act of 1933, as amended.

              

      

      

      IF
THE INVESTOR HAS ANSWERED YES TO QUESTION 2.1 ABOVE, THE INVESTOR MAY SKIP
QUESTIONS 2.2 THROUGH 2.8.  IF THE INVESTOR HAS ANSWERED NO TO
QUESTION 2.1 ABOVE, QUESTIONS 2.2 THROUGH 2.8 MUST BE ANSWERED.

      

      
        	
                 
      

              	
                2.2

              	
                The
      undersigned Investor certifies that (i) it has total assets in excess of
      $5,000,000, (ii) it is either an organization described in Section
      501(c)(3) if the Internal Revenue Code, a corporation, a Massachusetts or
      similar business trust, or a partnership, and (iii) it was not formed for
      the specific purpose of investing in
Shares.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.3

              	
                The
      undersigned Investor certifies that it is a broker or dealer registered
      pursuant to Section 15 of the Securities Exchange Act of 1934, as amended
      and purchasing Shares for its own
account.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.4

              	
                The
      undersigned Investor certifies that it is a private business development
      company as defined in Section 202(a)(22) of the Investment Advisors Act of
      1940.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.5

              	
                The
      undersigned Investor certifies that it is a bank or savings and loan
      association as defined in the Sections 3(a)(2) and 3(a)(5)(A),
      respectively, of the Securities Act of 1933, as amended acting either in
      its individual or fiduciary
capacity.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.6

              	
                The
      undersigned Investor certifies that it is an insurance company as defined
      in Section 2(13) of the Securities Act of 1933, as
  amended.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.7

              	
                The
      undersigned Investor certifies that it is an investment company registered
      under the Investment Company Act of 1940 or a business development company
      as defined in Section 2(a)(48) of  the Investment Company Act of
      1940.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      

      
        	
                 
      

              	
                2.8

              	
                The
      undersigned Investor certifies that it is a Small Business Investment
      Company licensed by the U.S. Small Business Administration under Section
      301(c) or (d)  of the Small Business investment Act of
      1958.

              

      

      

      
        	
                o   Yes

              	
                o   No

              

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      ACCEPTANCE

      

      On behalf of Mint Capital, Inc., the
undersigned authorized officer hereby accepts the foregoing Subscription
Application and agrees to cause certificates representing the Shares to the
foregoing subscriber.

      

      

      Dated:                                           MINT CAPITAL,
INC.

      

      

      

      By:____________________________

      Its:

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