Rush Street Interactive, Inc DEFA14A, filed Jul 28, 2020

Rush Street Interactive, Inc. (RSI)

DEFA14A 2020-07-28

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☐		Preliminary Proxy Statement

☐		Confidential, for Use of the Commission Only (as permitted by Rule 14a-6(e)(2))

☐		Definitive Proxy Statement

☐		Definitive Additional Materials

☒		Soliciting Material Pursuant to §240.14a-12



☒	No fee required.

☐	Fee computed on table below per Exchange Act Rules 14a-6(i)(1) and 0-11.

	(1)	Title of each class of securities to which transaction applies:
	(2)	Aggregate number of securities to which transaction applies:
	(3)	Per unit price or other underlying value of transaction computed pursuant to Exchange Act Rule 0-11 (set forth the amount on which the filing fee is calculated and state how it was determined):
	(4)	Proposed maximum aggregate value of transaction:
	(5)	Total fee paid:

☐	Fee paid previously with preliminary materials.

☐	Check box if any part of the fee is offset as provided by Exchange Act Rule 0-11(a)(2) and identify the filing for which the offsetting fee was paid previously. Identify the previous filing by registration statement number, or the Form or Schedule and the date of its filing.

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	(2)	Form, Schedule or Registration Statement No.:
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	(4)	Date Filed:


Delaware	001-39232	84-3626708
(State or other jurisdiction of incorporation)	(Commission File Number)	(IRS Employer Identification No.)


Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Units, each consisting of one share of Class A common stock and one-half of one redeemable warrant	DMYT.U	The New York Stock Exchange
Class A common stock, par value $0.0001 per share	DMYT	The New York Stock Exchange
Warrants, each whole warrant exercisable for one share of Class A common stock, each at an exercise price of $11.50 per share	DMYT WS	The New York Stock Exchange


Exhibit No.		Description
2.1*		Business Combination Agreement, dated as of July 27, 2020, by and between the Company, Rush Street Interactive, LP, the sellers set forth on the signatures pages thereto, dMY Sponsor, LLC and Rush Street Interactive GP, LLC.

10.1		Amended Insider Letter, dated as of July 27, 2020, by and between the Company, dMY Sponsor, LLC, Rush Street Interactive, LP, Rush Street Interactive GP, LLC and the other parties thereto.

10.2		Form of Fidelity Subscription Agreement.

10.3		Form of Other Subscription Agreements.


DMY TECHNOLOGY GROUP, INC.

By:		/s/ Niccolo de Masi
		Name: Niccolo de Masi
		Title: Chief Executive Officer


		Page
ARTICLE I CERTAIN DEFINITIONS			4
Section 1.1	Certain Definitions		4
ARTICLE II PURCHASE AND SALE TRANSACTIONS			28
Section 2.1	Purchase and Sale of Acquired Company Units; Issuance of Buyer Class V Voting Stock		28
Section 2.2	Purchase Price and Closing Date Payments		31
Section 2.3	Transaction Statement; Available Closing Date Cash; Third Party Invoices		31
Section 2.4	Example Pro Forma Calculations		34
Section 2.5	Closing Transactions		34
Section 2.6	Conditions to the Obligations of the Parties		34
Section 2.7	Company and Sellers Closing Deliveries		38
Section 2.8	Buyer Closing Deliveries		39
Section 2.9	Earnout		39
Section 2.10	Withholding		43
ARTICLE III REPRESENTATIONS AND WARRANTIES REGARDING THE RSI COMPANIES			44
Section 3.1	Organization; Authority; Enforceability		44
Section 3.2	Noncontravention		45
Section 3.3	Capitalization		45
Section 3.4	Financial Statements; No Undisclosed Liabilities		47
Section 3.5	No Material Adverse Effect		48
Section 3.6	Absence of Certain Developments		48
Section 3.7	Real Property		48
Section 3.8	Tax Matters		49
Section 3.9	Contracts		51
Section 3.10	Intellectual Property		54
Section 3.11	Data Security; Data Privacy		57
Section 3.12	Information Supplied		58
Section 3.13	Litigation		58
Section 3.14	Brokerage		58
Section 3.15	Labor Matters		58
Section 3.16	Employee Benefit Plans		60
Section 3.17	Insurance		62
Section 3.18	Compliance with Laws; Permits		63
Section 3.19	[Reserved]		63
Section 3.20	Title to and Sufficiency of Assets; No Bankruptcy		63
Section 3.21	Gaming		64
Section 3.22	Trade & Anti-Corruption Compliance		65
Section 3.23	Anti-Money Laundering Compliance		65
Section 3.24	Affiliate Transactions		66
Section 3.25	Compliance with Applicable Sanctions and Embargo Laws		66
Section 3.26	Inspections; Buyer’s Representations		67


ARTICLE IV REPRESENTATIONS AND WARRANTIES OF SELLERS		67
Section 4.1	Organization; Authority; Enforceability	68
Section 4.2	Capitalization	68
Section 4.3	Noncontravention	68
Section 4.4	Information Supplied	69
Section 4.5	Litigation	69
Section 4.6	Brokerage	69
Section 4.7	Investment Intent	69
Section 4.8	Compliance with Laws	70
Section 4.9	Inspections; Buyer’s Representations	70
ARTICLE V REPRESENTATIONS AND WARRANTIES OF THE BUYER		71
Section 5.1	Organization; Authority; Enforceability	71
Section 5.2	Capitalization	71
Section 5.3	Brokerage	73
Section 5.4	Trust Account	73
Section 5.5	Buyer SEC Documents; Controls	73
Section 5.6	Information Supplied; Proxy Statement	75
Section 5.7	Litigation	75
Section 5.8	Listing	75
Section 5.9	Investment Company	76
Section 5.10	Noncontravention	76
Section 5.11	Business Activities	76
Section 5.12	Investment Intent	77
Section 5.13	Tax Matters	77
Section 5.14	Compliance with Laws	79
Section 5.15	Inspections; Company and Sellers’ Representations	79
Section 5.16	Subscription Agreements	80
ARTICLE VI INTERIM OPERATING COVENANTS		80
Section 6.1	Interim Operating Covenants	80
Section 6.2	Interim Operating Covenants (Buyer)	84
ARTICLE VII PRE-CLOSING AGREEMENTS		86
Section 7.1	Commercially Reasonable Efforts; Further Assurances	86
Section 7.2	Trust & Closing Funding	87
Section 7.3	Listing	87
Section 7.4	LTIP	87
Section 7.5	Confidential Information	87
Section 7.6	Access to Information	88
Section 7.7	Notification of Certain Matters	88
Section 7.8	Regulatory Approvals; Efforts	88
Section 7.9	Communications; Press Release; SEC Filings	90
Section 7.10	Expenses	94
Section 7.11	Releases	95
Section 7.12	Directors and Officers	97
Section 7.13	Employee Matters	98
Section 7.14	Chief Financial Officer	98
Section 7.15	Equity Financing; Cooperation	98


Section 7.16	[Reserved]	100
Section 7.17	Stock Transactions	100
Section 7.18	[Reserved.]	100
Section 7.19	Buyer A&R Certificate of Incorporation and Buyer A&R Bylaws	100
Section 7.20	Name Change	100
Section 7.21	Exclusivity	100
Section 7.22	GP Company LLCA	101
Section 7.23	Additional Special Limited Partner	101
ARTICLE VIII ADDITIONAL AGREEMENTS		102
Section 8.1	Access to Books and Records	102
Section 8.2	Transferred Names	103
ARTICLE IX TAX MATTERS		103
Section 9.1	Certain Tax Matters	103
ARTICLE X TERMINATION		109
Section 10.1	Termination	109
Section 10.2	Effect of Termination	112
ARTICLE XI MISCELLANEOUS		112
Section 11.1	Amendment and Waiver	112
Section 11.2	Waiver of Remedies; Survival of Representations and Warranties	112
Section 11.3	Sellers’ Representative	113
Section 11.4	Notices	114
Section 11.5	Assignment	115
Section 11.6	Severability	115
Section 11.7	Interpretation	115
Section 11.8	Entire Agreement	116
Section 11.9	Counterparts; Electronic Delivery	116
Section 11.10	Governing Law; Waiver of Jury Trial; Jurisdiction	117
Section 11.11	Trust Account Waiver	117
Section 11.12	Specific Performance	118
Section 11.13	No Third-Party Beneficiaries	118
Section 11.14	Disclosure Letters and Exhibits	119
Section 11.15	No Recourse	119
Section 11.16	Legal Representation	120
Section 11.17	Acknowledgement	122
Section 11.18	Equitable Adjustments	123


Notices to Sellers, and prior to the Closing, the Company		with copies to:

Rush Street Interactive, LP 900 N. Michigan Avenue, Suite 1600 Chicago, Illinois 60611 Attention: Neil Bluhm and Greg Carlin Email:neilb@lambllc.com gcarlin@rushst.com		Kirkland & Ellis LLP 300 North LaSalle Chicago, Illinois 60654 Attention: Richard Campbell, P.C. and Karen E. Flanagan E-mail: richard.campbell@kirkland.com; karen.flanagan@kirkland.com

Notices to the Buyer, the Sponsor, and following the Closing, the Company:		with a copy to (which shall not constitute notice):


BUYER:

DMY TECHNOLOGY GROUP, INC.

By:		/s/ Niccolo de Masi
Name:		Niccolo de Masi
Title:		Chief Executive Officer


COMPANY:

RUSH STREET INTERACTIVE, LP

By:		Rush Street Interactive GP, LLC
Title:		General Partner

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Chief Executive Officer


SPONSOR:

dMY SPONSOR, LLC

By:		/s/ Harry L. You
Name:		Harry L. You
Title:		Managing Director


SELLERS’ REPRESENTATIVE:

RUSH STREET INTERACTIVE GP, LLC

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Chief Executive Officer


SELLERS:

RUSH STREET INTERACTIVE GP, LLC

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Chief Executive Officer


SELLERS:

GREG AND MACY CARLIN FAMILY TRUST

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Trustee


SELLERS:

Rush Street Investors, LLC

By: Rush Street Interactive GP, LLC, its managing member

By:		/s/ Neil Bluhm
Name:		Neil Bluhm
Title:		Manager


SELLERS:

NGB 2013 DYNASTY TRUST

By:		/s/ Neil Bluhm
Name:		Neil Bluhm
Title:		Trustee

	TABLE OF CONTENTS
ARTICLE I DEFINED TERMS .................................................................................................................................		1
Section 1.1	Definitions ...........................................................................................................................	1
Section 1.2	Interpretation .....................................................................................................................	13
ARTICLE II GENERAL PROVISIONS .................................................................................................................		14
Section 2.1	Formation..........................................................................................................................	14
Section 2.2	Name.................................................................................................................................	14
Section 2.3	Principal Place of Business; Other Places of Business ......................................................	14
Section 2.4	Designated Agent for Service of Process..........................................................................	14
Section 2.5	Term ..................................................................................................................................	14
Section 2.6	No Concerted Action .........................................................................................................	14
Section 2.7	Business Purpose ...............................................................................................................	15
Section 2.8	Powers ...............................................................................................................................	15
Section 2.9	Certificates; Filings...........................................................................................................	15
Section 2.10	Representations and Warranties by the Partners...............................................................	15
Section 2.11	Gaming Laws....................................................................................................................	16
Section 2.12	References to Certain Equity Securities............................................................................	16
ARTICLE III CLASSES OF PARTNERSHIP INTERESTS; CAPITAL CONTRIBUTIONS ........................		17
Section 3.1	Classes of Partnership Interests; Capital Contributions of the Partners............................	17
Section 3.2	Issuances of Additional Partnership Interests ....................................................................	17
Section 3.3	Additional Funds and Capital Contributions .....................................................................	18
Section 3.4	Issuances; Repurchases and Redemptions; Recapitalizations...........................................	18
Section 3.5	No Interest; No Return......................................................................................................	21
Section 3.6	Capital Accounts...............................................................................................................	21
ARTICLE IV DISTRIBUTIONS.............................................................................................................................		21
Section 4.1	Distributions ......................................................................................................................	21
Section 4.2	Tax Distributions ...............................................................................................................	22
Section 4.3	Distributions in Kind .........................................................................................................	22
Section 4.4	Distributions to Reflect Additional Partnership Units .......................................................	22
Section 4.5	Restricted Distributions .....................................................................................................	22
Section 4.6	Use of Distributions..........................................................................................................	22
ARTICLE V ALLOCATIONS.................................................................................................................................		22
Section 5.1	General Allocations ...........................................................................................................	22
Section 5.2	Additional Allocation Provisions......................................................................................	23
Section 5.3	Tax Allocations.................................................................................................................	25
Section 5.4	Other Allocation Rules ......................................................................................................	25
Section 5.5	Earnout Company Units....................................................................................................	25
ARTICLE VI OPERATIONS ...................................................................................................................................		26
Section 6.1	Management ......................................................................................................................	26
Section 6.2	Compensation and Advances............................................................................................	28
Section 6.3	Outside Activities ..............................................................................................................	29
Section 6.4	Transactions with Affiliates..............................................................................................	30
Section 6.5	Liability of Partners; Fiduciary and Other Duties; Indemnification ..................................	30
Section 6.6	Indemnification.................................................................................................................	31
ARTICLE VII RIGHTS AND OBLIGATIONS OF LIMITED PARTNERS ......................................................		32
Section 7.1	Return of Capital...............................................................................................................	32
Section 7.2	Rights of Limited Partners Relating to the Partnership .....................................................	33

ARTICLE VIII BOOKS AND RECORDS ..............................................................................................................			33
Section 8.1		Books and Records ............................................................................................................	33
Section 8.2		Inspection..........................................................................................................................	33
ARTICLE IX TAX MATTERS ................................................................................................................................			33
Section 9.1		Preparation of Tax Returns ................................................................................................	33
Section 9.2		Tax Elections .....................................................................................................................	33
Section 9.3		Partnership Representative. ...............................................................................................	34
(f)	Withholding Tax Indemnification...................................................................................................		35
ARTICLE X PARTNER TRANSFERS AND WITHDRAWALS .........................................................................			36
Section 10.1		Transfer.............................................................................................................................	36
Section 10.2		Transfer of General Partner's Partnership Interest............................................................	36
Section 10.3		Limited Partners' Rights to Transfer .................................................................................	36
Section 10.4		Substituted Limited Partners.............................................................................................	37
Section 10.5		Assignees..........................................................................................................................	38
Section 10.6		General Provisions............................................................................................................	38
ARTICLE XI ADMISSION OF PARTNERS.........................................................................................................			40
Section 11.1		Admission of Successor General Partner..........................................................................	40
Section 11.2		Partners; Admission of Additional Limited Partners........................................................	40
Section 11.3		Limit on Number of Partners .............................................................................................	41
Section 11.4		Admission.........................................................................................................................	41
ARTICLE XII DISSOLUTION, LIQUIDATION AND TERMINATION..........................................................			41
Section 12.1		No Dissolution..................................................................................................................	41
Section 12.2		Events Causing Dissolution ...............................................................................................	41
Section 12.3		Distribution upon Dissolution...........................................................................................	41
Section 12.4		Rights of Holders..............................................................................................................	43
Section 12.5		Termination .......................................................................................................................	43
Section 12.6		Reasonable Time for Winding-Up....................................................................................	43
ARTICLE XIII AMENDMENTS; MEETINGS.....................................................................................................			43
Section 13.1		Amendments.....................................................................................................................	43
Section 13.2		Procedures for Meetings and Actions of the Partners.......................................................	43
ARTICLE XIV EXCHANGE RIGHTS ...................................................................................................................			44
ARTICLE XV MISCELLANEOUS .........................................................................................................................			49
Section 15.1		Partnership Counsel ...........................................................................................................	49
Section 15.2		Appointment of General Partner as Attorney-in-Fact.......................................................	50
Section 15.3		Arbitration .........................................................................................................................	50
Section 15.4		Accounting and Fiscal Year..............................................................................................	51
Section 15.5		Entire Agreement..............................................................................................................	51
Section 15.6		Further Assurances ............................................................................................................	51
Section 15.7		Notices..............................................................................................................................	52
Section 15.8		Governing Law ..................................................................................................................	52
Section 15.9		Construction......................................................................................................................	52
Section 15.10		Binding Effect...................................................................................................................	52
Section 15.11		Severability.......................................................................................................................	52
Section 15.12		Confidentiality ...................................................................................................................	52
Section 15.13		Consent to Use of Name ....................................................................................................	55
Section 15.14		Consent by Spouse............................................................................................................	55
Section 15.15		Counterparts......................................................................................................................	55
Section 15.16		Survival.............................................................................................................................	55
Section 15.17		Anti-Money Laundering Representations and Undertakings............................................	55
		iii

	SCHEDULE I: OWNERSHIP
	(as of the Closing Date)2

Partner		Class A Common Units

Rush Street Interactive, Inc.		[•] (of which [•] are Earnout Company
Rush Street Interactive, Inc.		Units)
		Units)

[Original Limited Partner]		[•] (of which [•] are Earnout Company
[Original Limited Partner]		Units)
		Units)

[Original Limited Partner]		[•] (of which [•] are Earnout Company
[Original Limited Partner]		Units)
		Units)

[Original Limited Partner]		[•] (of which [•] are Earnout Company
[Original Limited Partner]		Units)
		Units)

Total		[•]

	TABLE OF CONTENTS
		Page
ARTICLE I DEFINITIONS .........................................................................................		2
Section 1.1	Definitions ..........................................................................................	2
ARTICLE II DETERMINATION OF CERTAIN REALIZED TAX BENEFIT ...		11
Section 2.1	Basis Schedule...................................................................................	11
Section 2.2	Tax Benefit Schedule.........................................................................	12
Section 2.3	Procedures, Amendments ...................................................................	13
Section 2.4	Section 754 Election..........................................................................	14
ARTICLE III TAX BENEFIT PAYMENTS ..............................................................		14
Section 3.1	Payments............................................................................................	14
Section 3.2	No Duplicative Payments ...................................................................	15
Section 3.3	Pro Rata Payments.............................................................................	16
Section 3.4	Payment Ordering..............................................................................	16
Section 3.5	Overpayments....................................................................................	16
ARTICLE IV TERMINATION ...................................................................................		16
Section 4.1	Early Termination of Agreement; Breach of Agreement ...................	16
Section 4.2	Early Termination Notice ...................................................................	18
Section 4.3	Payment upon Early Termination......................................................	18
ARTICLE V SUBORDINATION AND LATE PAYMENTS ...................................		19
Section 5.1	Subordination.....................................................................................	19
Section 5.2	Late Payments by the Corporate Taxpayer........................................	19
ARTICLE VI NO DISPUTES; CONSISTENCY; COOPERATION.......................		20
Section 6.1	Participation in the Corporate Taxpayer's and OpCo's Tax Matters	20
Section 6.2	Consistency........................................................................................	20
Section 6.3	Cooperation ........................................................................................	20
ARTICLE VII MISCELLANEOUS ............................................................................		21
Section 7.1	Notices ................................................................................................	21
Section 7.2	Counterparts.......................................................................................	21
Section 7.3	Entire Agreement; No Third Party Beneficiaries ...............................	22
Section 7.4	Governing Law ...................................................................................	22
Section 7.5	Severability........................................................................................	22
Section 7.6	Successors; Assignment; Amendments; Waivers..............................	22
Section 7.7	Interpretation ......................................................................................	23
Section 7.8	Waiver of Jury Trial; Jurisdiction......................................................	24
Section 7.9	Reconciliation....................................................................................	25
Section 7.10	Withholding ........................................................................................	26
Section 7.11	Admission of the Corporate Taxpayer into a Consolidated Group;	26
	Transfers of Corporate Assets ............................................................
Section 7.12	Confidentiality ....................................................................................	27
Section 7.13	TRA Party Representative ..................................................................	28
Exhibits and Schedules
Exhibit A - Form of Joinder

Class A Common Stock Beneficially Owned by the Sponsor		Number of
(and its Permitted Transferees) as a Percentage of the Class A		Sponsor
Common Stock Held by the Sponsor on the Closing Date		Directors
50% or greater	2
25% to less than 50%	1
Less than 25%	0

and the Amended Letter, made as of		, is between
("Transferor") and	("Transferee")	.
WHEREAS, as of the date hereof, Transferee is acquiring			Registrable Securities
(the "Acquired Interests") from Transferor;

			Schedule 1
			SERVICES

	Category		Description of Service

1.	Development	1.1	Development including assistance in new market
			identification, negotiation, and execution on joint venture
			agreements
2.	Government	2.1	Government Affairs functions including monitoring
	Affairs		legislative activity, supervision of contract lobbyists, and
			lobbying
3.	Legal and	3.1	Legal including contract review, negotiation, and
	Compliance		coordination on certain legal issues with respect to material
			corporate transactions
		3.2	Review and coordination of all corporate organizational
			documents and matters
		3.3	Gaming regulatory assistance, including review and
			coordination of all filings with gaming authorities and
			coordination with gaming authorities on regulatory issues
		3.4	Compliance including consultation, completion of
			applications, management of certain shared services, and
			discussions with regulators
4.	Human	4.1	Human Resources including administrative assistance,
	Resources		onboarding, recruiting, online learning administration,
			compliance audit requests, COBRA administration, and
			employee issue resolution assistance
		4.2	Payroll including managing periodic payroll, funding
			amounts, reporting, proper withholding, preparation of
			employee time sheets, and timely filing of required forms
			and documents
		4.3	Benefits including managing onboarding, leave
			administration, benefit strategy, broker selection, and
			general administration
5.	Finance and	5.1	Financial Reporting including monthly review of financial
	Accounting		statements, financial audit assistance, budget review and
			accounting issue resolution
		5.2	Tax Accounting including strategy for corporate structure,
			domestic and international structuring, review of tax returns,
			and tax estimates
		5.3	Procurement including general procurement of certain
			products and services, including certain shared services
		5.4	Disbursements including general disbursement approval and
			bank approvals

	Category		Description of Service

		5.5	Treasury including management of bank relationships and
			accounts
6.	IT	6.1	Information Technology including desktop support, general
			IT administration, information security, and management of
			certain shared services
7.	Insurance	7.1 Insurance brokerage and claims monitoring

	Schedule I
	Members

Member		Membership Interest
dMY Technology Group, Inc.
c/o dMY Sponsor, LLC		100%
1180 North Town Center Drive, Suite 100		100%
Las Vegas, Nevada 89144
Attention: [•]
Email: [•]


DMY SPONSOR, LLC

By:		/s/ Harry L. You
Name:		Harry L. You
Title:		Managing Director

/s/ Niccolo de Masi
Niccolo de Masi

/s/ Harry L. You
Harry L. You

/s/ Darla Anderson
Darla Anderson

/s/ Francesca Luthi
Francesca Luthi

/s/ Charles E. Wert
Charles E. Wert


SELLERS’ REPRESENTATIVE:

RUSH STREET INTERACTIVE GP, LLC

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Chief Executive Officer

TARGET:

RUSH STREET INTERACTIVE, LP

By:		Rush Street Interactive GP, LLC
Title:		General Partner

By:		/s/ Gregory Carlin
Name:		Gregory Carlin
Title:		Chief Executive Officer



Address for Notices:

1180 NORTH TOWN CENTER DRIVE, SUITE 100 LAS VEGAS NV 89144
ATTN: Niccolo de Masi, Chief Executive Officer EMAIL: niccolo@dmytechnology.com with a copy (not to constitute notice) to: WHITE & CASE LLP 1221 AVENUE OF THE AMERICAS NEW YORK, NY 10020 ATTN: Joel Rubinstein Elliott Smith EMAIL: joel.rubinstein@whitecase.com elliott.smith@whitecase.com


	SUBSCRIBER:


	Print Name:	[Various funds and accounts managed by Fidelity Management & Research Company]

	By:
		Name:
		Title:

	Address for Notices:




	Name in which shares are to be registered:


Number of Subscribed Shares subscribed for:

Price Per Subscribed Share:	$10.00

Aggregate Purchase Price:	$



Address for Notices:

900 NORTH MICHIGAN AVENUE SUITE 1600 CHICAGO, IL 60611 ATTN: Neil Bluhm Greg Carlin EMAIL: neilb@lambllc.com gcarlin@rushst.com with a copy (not to constitute notice) to: KIRKLAND & ELLIS LLP 300 N. LASALLE CHICAGO, IL 60654 ATTN: Richard J. Campbell, P.C. Karen E. Flanagan EMAIL: rcampbell@kirkland.com karen.flanagan@kirkland.com


	SUBSCRIBER:

	Print
	Name:

	By:
		Name:
		Title:

	Address for Notices:



	Name in which shares are to be registered:


Number of Subscribed Shares subscribed for:

Price Per Subscribed Share:	$10.00

Aggregate Purchase Price:	$