<SEC-DOCUMENT>0000947986-13-000184.txt : 20130719
<SEC-HEADER>0000947986-13-000184.hdr.sgml : 20130719
<ACCEPTANCE-DATETIME>20130719124955
ACCESSION NUMBER:		0000947986-13-000184
CONFORMED SUBMISSION TYPE:	497
PUBLIC DOCUMENT COUNT:		2
FILED AS OF DATE:		20130719
DATE AS OF CHANGE:		20130719
EFFECTIVENESS DATE:		20130719

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			CION Investment Corp
		CENTRAL INDEX KEY:			0001534254
		IRS NUMBER:				453058280
		STATE OF INCORPORATION:			MD
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		497
		SEC ACT:		1933 Act
		SEC FILE NUMBER:	333-178646
		FILM NUMBER:		13976463

	BUSINESS ADDRESS:	
		STREET 1:		3 PARK AVENUE
		STREET 2:		36TH FLOOR
		CITY:			NEW YORK
		STATE:			NY
		ZIP:			10016
		BUSINESS PHONE:		212 - 418 - 4700

	MAIL ADDRESS:	
		STREET 1:		3 PARK AVENUE
		STREET 2:		36TH FLOOR
		CITY:			NEW YORK
		STATE:			NY
		ZIP:			10016

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	C&#298;ON Investment Corp
		DATE OF NAME CHANGE:	20111104
</SEC-HEADER>
<DOCUMENT>
<TYPE>497
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<div style="TEXT-ALIGN: right; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold"><a name="eolPage1"><!--EFPlaceholder--></a><a name="FIS_TOP_OF_DOCUMENT"><!--EFPlaceholder--></a><a name="V331439_497_HTM"><!--EFPlaceholder--></a><a name="FIS_FORM"><!--EFPlaceholder--></a>Filed pursuant to Rule 497</font></div>

<div style="TEXT-ALIGN: right; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">File No. 333-178646</font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">C<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman">&#298;</font>ON INVESTMENT CORPORATION</font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Supplement No. 2&#160;dated July 19, 2013</font></div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">To</font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Prospectus dated June 12, 2013</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">This supplement contains information that amends, supplements or modifies certain information contained in the accompanying prospectus of C<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman">&#298;</font>ON Investment Corporation dated June 12, 2013, as previously supplemented and&#160;amended&#160;(as so supplemented and&#160;amended, the &#8220;Prospectus&#8221;). This supplement is part of, and should be read in conjunction with, the Prospectus. The Prospectus has been filed with the U.S. Securities and Exchange Commission, and is available free of charge at www.sec.gov or by calling (877) 822-4276. Capitalized terms used in this supplement have the same meanings as in the Prospectus, unless otherwise stated herein.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="FONT-STYLE: italic; DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Before investing in shares of our common stock, you should read carefully the Prospectus and this supplement and consider carefully our investment objective, risks, charges and expenses. You should also carefully consider the &#8220;Risk Factors&#8221; beginning on page 30 of the Prospectus before you decide to invest in our common stock.</font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">STATUS OF OUR PUBLIC OFFERING</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Since commencing our continuous public offering&#160; and through July 16, 2013, we received and accepted subscriptions in our offering for&#160;approximately&#160;4,895,000&#160;shares of our common stock at an average price per share of&#160;approximately $9.99,&#160;for corresponding gross proceeds of approximately&#160;$48.9&#160;million, including shares purchased by our affiliates and proceeds from our distribution reinvestment plan.</font></font></div>
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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">PORTFOLIO UPDATE</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt">
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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">As of&#160; July 15, 2013, our portfolio consisted of investments, acquired through primary and secondary market transactions at a weighted average purchase price of&#160;&#160;98.41% of par value, in the secured loans of&#160;21&#160;companies with a weighted average EBITDA (a non-GAAP measure commonly used by lenders to evaluate a company&#8217;s profitability) of&#160;$50.7&#160;million.<font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top">(1)</font>&#160; Presently, all of the investments in our portfolio are senior secured, floating-rate loans. Our estimated gross annual portfolio yield is&#160;7.49%.</font></font></font></div>

<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">&#160;</font></div>

<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Further, as of&#160; July 15, 2013, through a total return swap (more fully described in the Prospectus), we obtained the economic benefit of owning investments primarily in senior secured, first and second&#160;lien, floating-rate loans of&#160;35&#160;companies.<font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top">(1)</font></font></font></font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 11.4pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">DISTRIBUTIONS</font></font></font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12.55pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">On&#160;July 15, 2013, our board of directors&#160;(the</font>&#160; &#8220;Board&#8221;)&#160;declared two regular semi-monthly cash distributions o<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">f&#160;$0.029867 per share each (an annualized rate of 7.00% based on our current $10.24 per share public offering price), which will be paid in August 2013</font>. </font></font></font></font></div>

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<div style="TEXT-ALIGN: justify; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Both of the regular semi-monthly cash distributions of $0.029867 per share will be paid on August 1, 2013, the first to shareholders of record on July 15, 2013 and the second to shareholders of record on July 31, 2013.</font></font> </font></font></font></div>
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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12.55pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: normal"><font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">The determination of the tax attributes of our distributions is made annually as of the end of our fiscal year based upon our taxable income and distributions paid, in each case, for the full year. Therefore, a determination as to the tax attributes of the distributions made on a quarterly basis may not be representative of the actual tax attributes for a full year. We intend to update shareholders quarterly with an estimated percentage of our distributions that resulted from taxable ordinary income. The actual tax characteristics of distributions to shareholders will be reported to sha<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: normal">reholders annually on a Form 1099-DIV. </font></font></font></font></font></font></font></font><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top"><font style="DISPLAY: inline; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="FONT-WEIGHT: bold"><font style="FONT-WEIGHT: normal">The payment of future distributions on our common stock is subject to the discretion of the Board and applicable legal restrictions, and therefore, there can be no assurance as to the <font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">amount</font> or <font style="FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">timing</font> of any such<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-WEIGHT: normal"> future distributions.</font></font></font></font></font></font></font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 12.55pt; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">We may fund our cash distributions to shareholders from any sources of funds available to us, including offering proceeds, borrowings, net investment income from operations, capital gains proceeds from the sale of assets, non-capital gains proceeds from the sale of assets, dividends or other distributions paid to us on account of preferred and common equity investments in portfolio companies and expense reimbursements from ICON Investment Group, LLC (&#8220;IIG&#8221;), which are subject to recoupment. We have not established limits on the amount of funds we may use from available sources to make distributions. For a significant time after the commencement of our offering, a substantial portion of our distributions may result from expense reimbursements from IIG, which are subject to repayment by us within three years.&#160;The purpose of this arrangement is to avoid such distributions being characterized as returns of capital. Shareholders should understand that any such distributions are not based on our investment performance, and can only be sustained if we achieve positive investment performance in future periods and/or IIG continues to make such expense reimbursements. Shareholders should also understand that our future repayments will reduce the distributions that they would otherwise receive.&#160; There can be no assurance that we will achieve such performance in order to sustain these distributions, or be able to pay distributions at all.&#160; IIG has no obligation to provide expense reimbursements to us in future periods.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 11pt">This supplement amends and supplements the Prospectus by replacing in its entirety the Form of Subscription Agreement beginning on page A-2 </font><!--EFPlaceholder--><font style="DISPLAY: inline; FONT-SIZE: 11pt">of the Prospectus, with the revised Form of Subscription Agreement appended hereto.</font></font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">C<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman">&#298;</font>ON INVESTMENT CORPORATION</font></div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">INSTRUCTIONS TO INVESTORS &amp; SUBSCRIPTION AGREEMENT</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Please read carefully the Prospectus, as amended and supplemented, relating to the sale of shares of common stock (the &#8220;Shares&#8221;) in C<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman">&#298;</font>ON Investment Corporation (sometimes referred to herein as the &#8220;Company&#8221;) and all Exhibits thereto (the &#8220;Registration Statement&#8221;) before deciding to subscribe. This Offering is limited to investors who certify that they meet all of the qualifications set forth in the Prospectus (each, an &#8220;Investor&#8221;). If you meet these qualifications and desire to purchase our common stock, then please complete, execute and deliver the entire Subscription Agreement (as completed and signed) to the address provided below.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">You should examine this type of investment in the context of your own needs, investment objectives and financial capabilities and should make your own independent investigation and decision as to the risk and potential gain involved. Also, you are encouraged to consult with your own attorney, accountant, financial consultant or other business or tax advisor regarding the risks and merits of the proposed investment.<a name="FIS_UNIDENTIFIED_TABLE"><!--EFPlaceholder--></a></font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Your broker-dealer or registered investment adviser should MAIL properly completed and executed ORIGINAL documents, along with your check payable to &#8220;C<font style="DISPLAY: inline; FONT-FAMILY: Times New Roman">&#298;</font>ON Investment Corporation&#8221; to ICON Capital, LLC, the Administrator, at the following address:</font></div>

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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 54pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">Regular Mail:</font></div>

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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">Overnight:</font></div>

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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">430 West 7 <font style="DISPLAY: inline; FONT-SIZE: 70%; VERTICAL-ALIGN: text-top">th</font> Street</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: Times New Roman; FONT-SIZE: 11pt">Upon receipt of a signed Subscription Agreement, verification of your investment qualifications, and acceptance of your subscription by the Company (which reserves the right to accept or reject a subscription for any reason whatsoever), the Company will execute the Subscription Agreement and notify you of the receipt and acceptance of your subscription. In no event may a subscription for Shares be accepted until at least five (5) business days after the date the subscriber receives the final prospectus. The Company may accept or reject any subscription in whole or in part for a period of fifteen (15) days after receipt of the Subscription Agreement and any other subscription documents requested by the Company, verification of your investment qualifications and payment in full. Any subscription not accepted within fifteen (15) days of receipt will be deemed rejected. If rejected, all funds will be returned to subscribers without deduction for any expenses within ten business days from the date the subscription is rejected.</font></div>

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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">&#160;&#160;2.&#160;&#160;FORM OF OWNERSHIP</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Non-Custodial Ownership</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Custodial Arrangement</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">owner and custodian signature required</font> )</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;&#160;Individual</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">one signature required</font> )</font></font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Third Party Administered Custodial Plan</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">new IRA accounts will require an additional application</font> )</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Joint Tenants with Right of Survivorship</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">all parties must sign</font> )</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="35%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; PADDING-LEFT: 0pt; MARGIN-LEFT: 9pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"> IRA&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"> ROTH IRA&#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;ROLLOVER IRA&#160;&#160;</font></font></font></font></div>

<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 36pt; MARGIN-RIGHT: 0pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"> SEP&#160;</font></font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"> KEOGH</font></font></font></div>

<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Community Property</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">all parties must sign</font> )</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="35%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; PADDING-LEFT: 0pt; MARGIN-LEFT: 9pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"> OTHER</font><font style="DISPLAY: inline; FONT-SIZE: 10pt">&#160;&#160; </font></font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Tenants in Common</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">all parties must sign</font> )</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Name of Custodian:_____________________</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Tax ID Number:_______________________</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Custodian Acct. Number: ________________</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Date Acct. Established: __________________</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Phone Number: _________________________</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Name of Beneficial Owners/Beneficiaries: _______________</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Uniform Gift/Transfer to Minors (UGMA/UTMA)</font></font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">&#160;&#160;&#160;&#160;Under the </font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">UGMA/UTMA</font><font style="DISPLAY: inline; FONT-SIZE: 10pt"> of the State of&#160; </font></font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Mailing Address&#160; </font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Qualified Pension or Profit Sharing Plan</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">Include Plan Documents</font> )</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">City&#160;</font><font style="DISPLAY: inline; FONT-SIZE: 10pt">&#160;<font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;&#160;&#160;</font>&#160;&#160;&#160;&#160;&#160;State&#160;</font><font style="DISPLAY: inline; FONT-SIZE: 10pt">&#160;&#160;<font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;&#160;&#160;</font>&#160;&#160;Zip </font></font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Trust</font> ( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">Include title <font style="FONT-STYLE: italic; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">and</font> signature pages of Trust Documents</font> )</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 36pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> &#160;&#160; <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Corporation or Partnership</font> <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">( Include Corporate Resolution or Partnership Agreement,&#160; as&#160;&#160;applicable; authorized signature required )</font></font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font><font style="DISPLAY: inline; FONT-SIZE: 10pt"> &#160;&#160; </font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Other</font><font style="DISPLAY: inline; FONT-SIZE: 10pt"> </font><font style="DISPLAY: inline; FONT-SIZE: 10pt">( </font><font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">Include title and signature pages</font><font style="DISPLAY: inline; FONT-SIZE: 10pt"> )</font></font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="63%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">For Individual Ownership or JTWROS Only:</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt">&#160;&#160;</font><a name="fis_unidentified_table_6"><!--efplaceholder--></a></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;&#160;&#160;Transfer Upon Death&#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font></font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="35%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160;</font></div>
</td>
</tr></table>
</div>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">&#160;</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">&#160;</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">&#160;&#160;3.&#160;&#160;INVESTOR INFORMATION</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" colspan="5" valign="top" width="76%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">(Print name(s) and address exactly as they are to be registered on the account.)</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><a name="fis_beneficial_owners"><!--efplaceholder--></a><font style="FONT-SIZE: 10pt">&#160;Individual/Beneficial Owner</font></font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Name of Investor/Beneficial Owner</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Social Security or Tax ID Number </font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Street Address</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Email Address</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Daytime Phone Number</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="3" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Evening Phone Number</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Optional Mailing Address</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="38%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="9%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font></div>
</td>
</tr></table>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="12%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="37%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" colspan="5" valign="top" width="100%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Joint Owner</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Name of Co-Investor <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">(if applicable)</font></font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="12%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="37%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Social Security or Tax ID Number&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Street Address&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="12%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="37%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Email Address</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="12%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="37%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Daytime Phone Number</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="3" valign="top" width="51%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Evening Phone Number</font></div>
</td>
</tr><tr>
<td align="left" colspan="5" valign="top" width="100%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Optional Mailing Address</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="46%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="12%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="37%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font></div>
</td>
</tr></table>
</div>

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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></td>
<td align="left" valign="top" width="30%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></td>
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<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
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<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="8%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="22%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
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</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="10%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
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<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
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<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="10%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25">
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<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="10%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Date of Entity Formation</font></div>

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<td align="left" colspan="5" valign="top" width="76%" style="LINE-HEIGHT: 1.25">
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</tr><tr>
<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
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</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="10%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font></div>

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</td>
</tr><tr>
<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25">
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="3" valign="top" width="39%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Name(s) of Officer(s), General Partner or Authorized Person(s)</font></div>
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</tr><tr>
<td align="left" valign="top" width="36%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Jurisdiction of Formation: _________________________________&#160;</font></td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></td>
<td align="left" colspan="3" valign="top" width="39%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;</font></td>
</tr></table>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">
<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="8%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="22%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Select one.</font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="5" valign="top" width="50%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Backup Withholding:</font> Subject to backup withholding? <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> YES <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> NO</font></font></div>
</td>
<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr><tr>
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="5" valign="top" width="50%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">___________________________________________________________________________</font></div>
</td>
<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr></table>
</div>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="72%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="4%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="20%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="4%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr></table>
</div>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="8%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="22%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td valign="top" width="6%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Citizenship:</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="8%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr><tr>
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Select one.</font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="11%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> U.S. citizen</font></font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="25%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> U.S. citizen residing outside the U.S.</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Country:__________________________</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="8%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Resident Alien</font></font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="22%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Non resident</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Country:__________________________</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Select one.</font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="5" valign="top" width="50%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Backup Withholding:</font> Subject to backup withholding? <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> YES <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> NO</font></font></div>
</td>
<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr><tr>
<td align="left" valign="top" width="6%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="1%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="5" valign="top" width="50%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">___________________________________________________________________________</font></div>
</td>
<td colspan="2" valign="top" width="23%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
</tr></table>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="24%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">&#160;</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">&#160;</td>
</tr><tr>
<td align="left" colspan="7" valign="top" width="100%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold">&#160;&#160;4.&#160;&#160;DISTRIBUTIONS</font></div>
</td>
</tr><tr>
<td align="left" colspan="7" valign="top" width="100%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 6.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">I hereby subscribe for Shares of C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation and elect the distribution option indicated below:</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 6.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">IRA accounts may not direct distributions without the custodian&#8217;s approval</font> )</font></div>
</td>
</tr><tr>
<td valign="top" width="24%" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="FONT-SIZE: 10pt">&#160;o<font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">I choose to participate i</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">n C&#298;ON</font> </font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">
<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal"><font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;&#160;&#160;</font>&#160; Investment Corporation&#8217;s</font> </font></font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal"><font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;&#160;&#160;</font>&#160; Distribution Reinvestment</font> </font></font></font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: normal"><font style="FONT-SIZE: 10pt"><font id="TAB2" style="LETTER-SPACING: 9pt; FONT-SIZE: 10pt">&#160;&#160;&#160;</font>&#160; Plan.*</font></font></font></font></font></font></font></font></div>
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</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="27%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; PADDING-LEFT: 0pt; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="FONT-SIZE: 10pt">o <font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">I choose to have distributions deposited</font> </font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">
<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160;&#160;&#160; in a checking, savings or brokerage</font> </font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160; &#160; account.</font></font></font></font></font></div>
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</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="21%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="FONT-SIZE: 10pt">o <font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">I choose to have distributions</font> </font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">
<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160;&#160;&#160; mailed to me at the address</font> </font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160;&#160;&#160; listed in Section 3.</font></font></font></font></font></div>
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<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="21%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="FONT-SIZE: 10pt">o <font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">I choose to have distributions</font> </font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">
<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160;&#160;&#160;mailed to me at the following</font> </font></font></font></font></font>

<div style="LINE-HEIGHT: 13.7pt; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: normal">&#160;&#160;&#160;&#160;&#160;&#160;&#160;address:</font></font></font></font></font></div>
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<td align="left" valign="top" width="24%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="27%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left">&#160;</div>
</td>
</tr><tr>
<td colspan="7" valign="top" width="100%" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 6.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">*&#160;&#160;&#160;&#160;&#160;&#160;&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Each investor that elects to have his or her distributions reinvested in C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation&#8217;s Distribution Reinvestment Plan agrees to notify the&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Company and the broker-dealer named in this Subscription Agreement in writing at any time there is a material change in his or her financial condition,&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">including failure to meet the minimum income and net worth standards as imposed by the state in which he or she resides.</font></font></div>
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</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 18pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I authorize C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation or its agent to deposit my distribution to the account indicated below. This authority will remain in force until I notify C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation in writing to cancel it. In the event that C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation deposits funds erroneously into my account, the Company is authorized to debit my account for the amount of the erroneous deposit. I also hereby acknowledge that funds and/or Shares in my account may be subject to applicable abandoned property, escheat or similar laws and may be transferred to the appropriate governmental authority in accordance with such laws, including as a result of account inactivity for the period of time specified in such laws or otherwise. None of the Company, its affiliates, its agents or any other person shall be liable for any property delivered in good faith to a governmental authority pursuant to applicable abandoned property, escheat or similar laws.</font></div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25"><font style="FONT-SIZE: 10pt">&#160;</font></td>
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<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Name of Financial Institution</font></div>
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<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" colspan="3" valign="top" width="54%" style="LINE-HEIGHT: 1.25">
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</td>
</tr><tr>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">State</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Your Bank&#8217;s ABA Routing Number</font></div>
</td>
<td valign="top" width="3%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="21%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Your Account Number</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Account Type</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Checking &#160;&#160;&#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Savings &#160;&#160;&#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Brokerage</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left">&#160;</div>
</td>
</tr><tr>
<td colspan="5" valign="top" width="88%" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt"><font style="FONT-STYLE: italic; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">For Electronic Funds Transfers, the signatures of the bank account owner(s) must appear exactly as they appear on the bank registration. If the registration at the bank differs from that on this Subscription Agreement, all parties must sign below.</font></div>
</td>
</tr><tr>
<td align="left" colspan="3" valign="top" width="56%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Signature of Individual/Trustee/Beneficial Owner</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="31%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Signature of Co-Investor/Trustee</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr></table>
</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt">
<div style="LINE-HEIGHT: 0pt; TEXT-INDENT: 0pt; DISPLAY: block">&#160;</div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">In order to induce C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation to accept this subscription, I hereby represent and warrant as follows:</font></div>

<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt">( <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">A power of attorney may not be granted to any person to make such representations on behalf of investor(s).) Only fiduciaries such as trustees, guardians, conservators, custodians and personal representatives may make such representations on behalf of an Investor.</font></font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Investor</font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">a)&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I have received the final Prospectus of C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation at least five business days before signing the Subscription Agreement.</font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">b)&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I (we) certify that I (we) have (1) a net worth (exclusive of home, home furnishings and automobiles) of $250,000 or more; or (2) a net worth (exclusive of home, home furnishings and automobiles) of at least $70,000 and had during the last tax year or estimate that I (we) will have during the current tax year a minimum of $70,000 annual gross income, or that I (we) meet the higher suitability requirements imposed by my state of primary residence as set forth in the Prospectus under &#8220;Suitability Standards.&#8221;</font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160;</font></font></div>
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<td align="left" valign="top" width="1196" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">c)&#160;&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I am (we are) purchasing Shares for my (our) own account.</font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">d)&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I (we) acknowledge that the Shares are not liquid, there is no public market for the Shares, and I (we) may not be able to sell the Shares.</font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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</tr><tr>
<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">e)&#160;&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I am either purchasing the Shares on behalf of a trust or other entity of which I am trustee or authorized agent, I have due authority to execute this subscription agreement and do hereby legally bind the trust or other entity of which I am trustee or authorized agent.</font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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</tr><tr>
<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">f)&#160;&#160;&#160;&#160; &#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Alabama</font>, I (we) certify that I (we) have a net worth of at least 10 times my (our) investment in the Company and other similar programs.</font></font></div>
</td>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
</td>
<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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</tr><tr>
<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">g)&#160;&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">California</font>, I (we) certify that I (we) must limit my (our) investment in the Company to 10% of my (our) net worth (excluding home, home furnishings and automobiles).</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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</tr><tr>
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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">h)&#160;&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Iowa</font>, I (we) certify that I (we) have either (1) a net worth of $100,000 and annual gross income of $100,000; or (2) a liquid net worth of $350,000. I (we) further certify that my (our) total investment in the Company does not exceed 10% of my (our) liquid net worth.</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">i)&#160;&#160;&#160;&#160; &#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Kansas</font>, I (we)&#160;hereby acknowledge that the Office of the&#160;Securities Commissioner of Kansas recommends that I (we) should&#160; not invest, in the&#160;aggregate, more than 10% of my (our) liquid net&#160;worth&#160;in the Company and other non-traded business development companies. &#8220;Liquid net worth&#8221; is that portion of my (our)&#160;net worth that consists of cash, cash equivalents and readily marketable securities.</font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">j)&#160;&#160;&#160;&#160; &#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Kentucky</font>, I (we) certify that I (we) have either (1) a liquid net worth of $85,000 and annual gross income of $85,000; or (2) a liquid net worth of $300,000. I (we) further certify that my (our) total investment in the Company does not exceed 10% of my (our) liquid net worth.</font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">k)&#160;&#160; &#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Maine</font>, I (we)&#160;&#160;acknowledge that the Maine Office of Securities recommends that my (our) aggregate investment in the C</font></font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">ompany and similar offerings will not exceed 10% of my (our) liquid net worth.&#160;&#8220;Liquid net worth&#8221; is that portion of my (our) net worth that consists of cash, cash equivalents and readily marketable securities.</font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">l)&#160;&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Massachusetts</font>, I (we)&#160;hereby acknowledge that the Massachusetts Securities Division&#160;recommends&#160;that I (we) should not invest, in the aggregate, more than 10% of my (our) liquid net worth&#160;in the Company and in&#160;other illiquid business development companies or direct participation&#160; programs.</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160;</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">m)&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Nebraska</font>, I (we) certify that I (we) have: (i) either (a) an annual gross income of at least $100,000 and a net worth of at least $350,000, or (b) a net worth of at least $500,000; and (ii) I (we) will not invest more than 10% of my (our) net worth in the Company.</font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<td valign="top" width="109" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<td valign="top" width="1196" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">n)&#160;&#160;&#160;&#160; &#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">New Jersey</font>, I (we) certify that I (we) have either (i) a liquid net worth of $85,000 and annual gross income of $85,000 or (ii) liquid net worth of $300,000. Additionally, I (we) certify that my (our) total investment in the Company and other non-traded business development companies does not exceed 10% of my (our) liquid net worth.</font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160;&#160;</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">o)&#160;&#160;&#160;&#160;&#160;&#160;</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">New Mexico</font>, I (we) certify that my (our) aggregate investment in the Company and other non-traded business development companies does not exceed 10% of my (our) liquid net worth.</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials</font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
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<td valign="top" width="993" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Investor</font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Co-Investor</font></div>
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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">p)&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">North Dakota</font>, I (we) certify that I (we) (1) have a net worth of at least ten times my (our) investment in the Company and its affiliates and (2) meet one of the established net income/net worth or net worth suitability standards.</font></font></div>
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<td valign="top" width="93" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="993" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">q)&#160;&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Oregon</font>, I (we) certify that my (our) investment in the Company does not exceed 10% of my (our) liquid net worth, exclusive of home, home furnishings and automobiles.</font></font></div>
</td>
<td valign="top" width="93" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="100" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="993" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">r)&#160;&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Tennessee</font>, I (we) certify that I (we) have a minimum annual gross income of $100,000 and a minimum net worth of $100,000; or a minimum net worth of $500,000 exclusive of home, home furnishings and automobiles. In addition, I (we) certify that my (our) investment in the Company does not exceed 10% of my (our) liquid net worth.</font></font></div>
</td>
<td valign="top" width="93" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt">Initials&#160; </font></font></div>
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<td valign="top" width="993" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 27pt; MARGIN-RIGHT: 0.8pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">s)&#160;&#160;&#160;&#160;&#160;&#160; </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">If I am (we are) a resident of <font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Texas</font>, I (we) certify that I (we) have either (i) a minimum of $100,000 annual gross income and a liquid net worth of $100,000; or (ii) a liquid net worth of $250,000 irrespective of gross annual income. For this purpose, liquid net worth is determined exclusive of home, home furnishings and automobiles. In addition, I (we) certify that my (our) investment in the Company does not exceed 10% of my (our) liquid net worth. For this purpose, liquid net worth is determined exclusive of home, home furnishings and automobiles.</font></font></div>
</td>
<td valign="top" width="93" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 11pt"><font style="FONT-SIZE: 10pt">Initials&#160;</font> </font></font></div>
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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt"><font style="DISPLAY: inline; FONT-SIZE: 11pt">Initials&#160; </font></font></div>
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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">SUBSTITUTE IRS FORM W-9 CERTIFICATION</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">By signing below, you hereby acknowledge receipt of the Prospectus of the Company, as supplemented and amended through the date hereof, which supplements and amendments are available at <font style="FONT-STYLE: italic; DISPLAY: inline; FONT-SIZE: 10pt">www.sec.gov</font> , not less than five (5) business days prior to the signing of this Subscription Agreement. You are encouraged to read the Prospectus carefully before making any investment decisions. You agree that if this subscription is accepted, it will be held, together with the accompanying payment, on the terms described in the Prospectus. You agree that subscriptions may be rejected in whole or in part by the Company in its sole and absolute discretion.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">You understand that you will receive a confirmation of your purchase, subject to acceptance by the Company, within 15 days from the date your subscription is received, and that the sale of Shares pursuant to this Subscription Agreement will not be effective until at least five business days after the date you have received a final Prospectus.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">By signing below, you also acknowledge that you have been advised that the assignability and transferability of the Shares is restricted and governed by the terms of the Prospectus; there are risks associated with an investment in the Shares and you should rely only on the information contained in the Prospectus and not on any other information or representations from other sources; and you should not invest in the Shares unless you have an adequate means of providing for your current needs and personal contingencies and have no need for liquidity in this investment.</font></div>

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<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">The Company is required by law to obtain, verify and record certain personal information from you or persons on your behalf in order to establish the account. Required information includes name, date of birth, permanent residential address and social security/taxpayer identification number. We may also ask to see other identifying documents. If you do not provide the information, the Company may not be able to open your account. By signing the Subscription Agreement, you agree to provide this information and confirm that this information is true and correct. You further agree that the Company may discuss your personal information and your investment in the Shares at any time with your then current financial advisor. If we are unable to verify your identity, or that of another person(s) authorized to act on your behalf, or if we believe we have identified potentially criminal or other illegal activity, we reserve the right to take action as we deem appropriate which may include closing your account.</font></div>

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</tr><tr>
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<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Name of Participating Broker-Dealer or Financial Institution</font> &#160;&#160; <font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Check if recently employed by new Broker-Dealer or Financial Institution</font></font></div>

<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 4.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
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<div style="TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>

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<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="30%">
<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Rep./Adviser Number</font></div>
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<div style="TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
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<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt">o</font> Check if updated address</font></font></div>
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<div style="TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">City</font></div>

<div style="TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>

<div style="TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
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<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
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<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="30%">
<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Zip Code</font></div>
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<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Email</font></div>
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<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="26%">
<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="30%">
<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Phone Number</font></div>

<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>

<div style="TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Fax Number</font></div>
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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr>
<td colspan="3" valign="top" width="88%" style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25">
<div style="TEXT-ALIGN: justify; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">The undersigned confirms by its signature that it (i) has reasonable grounds to believe that the information and representations concerning the Investor identified herein are true, correct and complete in all respects; (ii) has verified that the form of ownership selected is accurate and, if other than individual ownership, has verified that the individual executing on behalf of the Investor is properly authorized and identified; (iii) has discussed such Investor&#8217;s prospective purchase of Shares with such Investor; (iv) has advised such Investor of all pertinent facts with regard to the liquidity and marketability of the Shares; (v) has delivered a current prospectus and related amendments and supplements, if any, to such Investor; (vi) no sale of Shares shall be completed until at least five (5) business days after the date the Investor receives a copy of the prospectus, as amended or supplemented; and (vii) has reasonable grounds to believe that the purchase of Shares is a suitable investment for such Investor, that such Investor meets the suitability standards applicable to such Investor set forth in the prospectus (as amended or supplemented as of the date hereof), and that such Investor is in a financial position to enable such Investor to realize the benefits of such an investment and to suffer any loss that may occur with respect thereto. The above-identified entity, acting in its capacity as agent, broker, financial advisor or other investor representative, has performed functions required by federal and state securities laws and, as applicable, FINRA rules and regulations, including, but not limited to Know Your Customer, Suitability and PATRIOT Act (AML, Customer Identification) as required by its relationship with the Investor(s) identified in this document.</font></div>
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<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">I understand this Subscription Agreement is for the offering of C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation</font></div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
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<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="13%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" valign="top" width="74%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Signature of Broker/Financial Advisor/Other Investor Representative</font></div>

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<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="13%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Date</font></div>
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<td align="left" valign="top" width="74%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Signature of Registered Principal</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>

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</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td align="left" valign="top" width="13%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">Date</font></div>
</td>
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</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="justify">&#160;</div>

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</div>

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</div>

<div style="TEXT-ALIGN: center; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block">
<table cellpadding="0" cellspacing="0" width="100%" style="LINE-HEIGHT: 1.25; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-SIZE: 10pt; FONT-FAMILY: times new roman">
<tr style="LINE-HEIGHT: 1.25;">
<td align="left" valign="top" width="44%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt">&#160; </font></td>
<td align="left" valign="top" width="43%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0pt" align="left">&#160;</div>
</td>
</tr><tr>
<td align="left" colspan="3" valign="top" width="88%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 18pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 11pt; FONT-WEIGHT: bold"><font style="DISPLAY: inline; FONT-SIZE: 11pt">&#160;&#160; </font>8.&#160;&#160;INVESTOR INSTRUCTIONS</font></div>

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</td>
</tr><tr>
<td colspan="3" valign="top" width="88%" style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; PADDING-LEFT: 0pt; MARGIN-LEFT: 9pt; MARGIN-RIGHT: 0pt">
<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 36pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o</font> <font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">By Mail</font> &#160;&#8211;&#160;Checks should be made payable to&#160;<font style="FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#8220;</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">C</font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#298;</font><font style="DISPLAY: inline; FONT-SIZE: 10pt; FONT-WEIGHT: bold">ON Investment Corporation&#8221;</font></font></font></font></div>

<div style="TEXT-ALIGN: left; LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 36pt; MARGIN-RIGHT: 0pt"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" colspan="3" valign="top" width="88%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">By Wire Transfer&#160;&#8211;&#160;UMB Bank, N.A., ABA Routing #101000695, C<font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#298;</font>ON Investment Corporation, Account #9871976041.</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; Forward this subscription agreement to the address listed below.</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" colspan="3" valign="top" width="88%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">By Asset Transfer</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;&#160;</font></div>
</td>
</tr><tr>
<td align="left" colspan="3" valign="top" width="88%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -27pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="FONT-SIZE: 10pt"><font style="DISPLAY: inline; FONT-FAMILY: wingdings; FONT-SIZE: 10pt; FONT-WEIGHT: bold">o </font><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Custodial Accounts&#160;&#8211;&#160;Forward this Subscription Agreement directly to the custodian.</font></font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: -18pt; DISPLAY: block; MARGIN-LEFT: 45pt; MARGIN-RIGHT: 0pt" align="left"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">&#160;&#160;</font></div>
</td>
</tr><tr>
<td colspan="3" valign="top" width="88%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 2.8pt" align="center"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold"><a name="fis_unidentified_table_12"><!--efplaceholder--></a><font style="FONT-SIZE: 10pt">MAILING INSTRUCTIONS</font></font></div>
</td>
</tr><tr>
<td valign="top" width="44%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: italic; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">REGULAR MAIL</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: normal; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">ICON Capital, LLC</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: normal; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">c/o DST Systems</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: normal; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">P.O. Box 219476</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: normal; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Kansas City, MO 64121-9476</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: normal; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt; FONT-WEIGHT: bold">Tel: (800) 343-3736</font></div>
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<td valign="top" width="2%" style="LINE-HEIGHT: 1.25"><font style="DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">&#160; </font></td>
<td valign="top" width="43%" style="LINE-HEIGHT: 1.25">
<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center"><font style="FONT-STYLE: italic; DISPLAY: inline; FONT-FAMILY: times new roman; FONT-SIZE: 10pt">OVERNIGHT</font></div>

<div style="LINE-HEIGHT: 1.25; TEXT-INDENT: 0pt; DISPLAY: block; MARGIN-LEFT: 0pt; MARGIN-RIGHT: 0.8pt" align="center">
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`
end
</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
