ATLAS GROUP LC

The undersigned BROKER accepts this exclusive appointment and agrees to use due diligence in the exercise of the Authority, Powers, and Duties granted under the terms and conditions hereof.  This Agreement shall be binding upon the Successors and Assignors of the BROKER and the Heirs, Administrators, Executors, Successors, and Assignors of the OWNER.  No amendment is valid unless in writing and signed by the parties.  There are no warranties or representations not herein contained.  In witness whereof the parties have affixed or caused to be affixed their

respective signatures this   _________ day of ___________________________________________  20 _______.

Owner:

SSN / Fed ID #

Print Name

Owner Signature

Owner:

SSN / Fed ID #

Print Name

Owner Signature

Owner:

Res Phone #

Print Name

Bus Phone#

Owner Signature

Owner:

Cell Phone #

Print Name

Other Phone #

Owner Signature

Email #1

Address:

Email #2

City/State/Zip:

Mail Check To

Atlas Group LC   (800)  270-0391  or   (702)  387-1354

Other Address:

4033 W. Charleston Blvd.,   Las Vegas,   NV   89102

BY:     AGENT/ BROKER