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DATE:_____________________
The undersigned guarantees the obligations of the Company regardless of what legal form the Company
has taken or shall take. In addition, the undersigned guarantees and represents that they are
stockholders, or directors, or officers and or are financially interested in the Company, and if married,
their martial communities are so interested.
Signature___________________________________________________________________________
Printed Name/Typed__________________________________________________________________
Residence
Address______________________________________________________________________________
_____________________________________________________________________________________
Social Security Number______-_______-_______
Date of Birth______/______/19________
Residence Phone Number (______) ________-________