PBSS ON-LINE

(PRIVATE BUYING & SELLING SECURITIES)

Form (Buyer) - Application to Open a Stock Purchase Escrow Account with a Transfer Agent or Bank

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Please print from your computer a filled in copy of this application and mail the information requested herein to the Transfer Agent or Bank with your check (Minimum amount of check $1000.). NOTE: The name and address of the Transfer Agent or Bank is printed at the botom right hand corner of your stock certificate. It is suggested that you phone the Issuer's Office (i.e., of the Public Corporation you hold stock in) and check to see if they are using the same Transfer Agent at this time, or if the Transfer Agent may have had a change of address.

INSTRUCTIONS: TO OPEN A STOCK PURCHASE ESCROW ACCOUNT AND ACQUIRE AN ESCROW ACCOUNT NUMBER AND PASS-WORD.

1. Please fill in form below, affix your signature(s), and print a copy for your records.

2. Print a second copy, affix your signature, include your check, and mail to the Transfer Agent indicated.

3. Upon receipt of your application and the minimum funds required ($1,000.) by the Transfer Agent or Bank your Escrow Account will be established. A personal Escrow Account Number will then be assigned to you along with the establishment of a CONFIDENTIAL PASSWORD. Allow 5 business days for this transaction to be completed (after your check has cleared). Funds forwarded from a foreign country must be in the form of an International Money Order in U.S. Dollars - - a longer period is required for the clearing of funds from a foreign country.

4. No interest will be paid to you in connection with these escrow funds. Upon written request your escrow funds will be refunded in full promptly (WITHIN (4) BUSINESS DAYS) - - NOTE: If the owner of the Stock Purchase Escrow Account has made no purchases through the PBSS On-Line System, a Termination Fee of $20.00 will be charged.

5. The owner of the Stock Purchase Escrow Account can have funds transferred to any U.S. or Foreign Bank or any Registered Transfer Agent in the U.S. upon formal request. Timing: Three (3) U.S. Business Days. (Wired funds can be effected at a nominal charge depending upon the Bank or Transfer Agent).

Att: Cash Stock Purchase Escrow Account Department

Gentlemen:

Attached herewith please find my check in the amount indicated below to open an ESCROW ACCOUNT in my (our) name with your firm. I agree to pay your firm a Transfer Fee of $20.00 for TRANSFERRING a new certificate into my (our) name upon my (our) making a purchase of common stock via the PBSS ON-LINE Buying System in the near future..

It is my understanding that I will be charged only a $20.00 Transfer Fee per each transaction regardless of the quantity of shares I purchase. One certificate will be issued in the denomination of my purchase.

Multiple certificates can be issued at an additional charge of $12.00 per each extra certificate issued.

Full Name(s):

Address:
City, State, Zip:

(Area Code) Phone:

Area Code) FAX:
Social.Security #:

Social Security #

Check Amount$:

Check Number:

Date:

Name of Bank

Address of Bank

E-Mail Address":

Copyright: Columbia Publishing Company - 1997 and 1998.
Last revised: December 18, 2002

FOR INFORMATION ON THE BUYER - - (CLICK)

*Full Name(s):*
*Address:* *City, State, Zip:*

*(Area Code) Phone:*
*Area Code) FAX:* *Social.Security #:* *Social Security #* *Check Amount$:* *Check Number:* *Date:*
Name of Bank

Address of Bank

*E-Mail Address":*

PBSS ON-LINE

(PRIVATE BUYING & SELLING SECURITIES)

Form (Buyer) - Application to Open a Stock Purchase Escrow Account with a Transfer Agent or Bank

Copyright: Columbia Publishing Company - 1997 and 1998. Last revised: December 18, 2002

Copyright: Columbia Publishing Company - 1997 and 1998.
Last revised: December 18, 2002