General Form 1-A Electronic Worksheet Instructions and Information

The following information must be provided for the XML-based portion of Form 1-A and must be completed or updated before filing each offering statement or amendment thereto. The format of Part I shown below may differ from the electronic version available on EDGAR. All items must be addressed, unless otherwise indicated.

References:

Regulation A: http://www.ecfr.gov/cgi-bin/text-idx?&mc=true&node=sg17.3.230_1240.sg2

SEC Form 1-A and Instructions: http://www.sec.gov/about/forms/form1-a.pdf

Worksheet Instructions:

Click Enable Content to activate all macros in this file. Macros make the form functional and user friendly. The worksheet macros are compatible with Word 2007 and higher.

Complete the worksheet in Print Layout View.

Red asterisks (*) indicate a required/mandatory field.

Edit only the gray fields in the worksheet.

Do not copy/paste special characters (e.g., em/en dashes, foreign language characters) into the worksheet. The SEC does not allow these types of characters in XML filings.

When using the Add or Remove buttons, please note that rows will always be added to the bottom and removed from the bottom of the table. Reordering is not an option.

Filer Information

Note:	Filer Information is collected only for verifying submission header information and proofing purposes.

Submission Type:*Select

Issuer Filer Information:

CIK:*	Click here to enter text.
(must be 10 digits, include leading 0’s)
CCC:*	Click here to enter text.
(8 character limit)
DOS File Number: (required for DOS/A (if a DOS has been previously filed) and optional for 1-A filings)	367-Click here to enter text.
Offering File Number: (required for 1-A/A and 1-A POS flings)	024-Click here to enter text.

Co-Issuer Filer Information:

Co-Issuer Name (for reference only) (up to 15 Co-Issuers may be added)	CIK	CCC	File Number
Enter Co-Issuer Filer Name.	Enter CIK.	Enter CCC.	Enter File Number.

(add, or remove, items as needed - only the most recently added row will be removed)
Enter Co-Issuer Filer Name.	Enter CIK.	Enter CCC.	Enter File Number.

Notification via e-mail address (up to 3 may be added):
Click here to enter text. Click here to enter text. Click here to enter text.

No changes to the information required by Part I have occurred since the last filing of this offering statement.

Note:	This box should only be checked, if applicable, for Forms DOS/A, 1-A/A and 1-A POS.

Item 1: Issuer Information

Exact name of issuer as specified in	Click here to enter text.
the issuer’s charter:*	(150 character limit)
(Note: This field must match the EDGAR profile on file with the SEC.)
Jurisdiction of incorporation / organization:*(SEC State/Country Codes)	Select
(Note: This field must match the EDGAR profile on file with the SEC.)
Year of Incorporation:*	Click here to enter text.
(YYYY format)
CIK:*	Click here to enter text.
(must be 10 digits, add leading 0’s)
Primary Standard Industrial Classification (SIC) Code:*	Select
(#### format)
I.R.S. Employer Identification Number:*	Click here to enter text.
(Note: This field must match the EDGAR profile on file with the SEC.)	(00-0000000 format)
Total number of full-time employees:*	Click here to enter text.
(7 digit limit)
Total number of part-time employees:*	Click here to enter text.
(7 digit limit)

(add, or remove, items as needed - only the most recently added table will be removed)

Note:	To verify that the above information on the Form matches your EDGAR profile exactly, please enter your CIK Number into the search field on the EDGAR Company Database Search.
(http://www.edgarcompany.sec.gov/servlet/CompanyDBSearch?page=main)
If you require changes to your EDGAR profile, please contact your Customer Service Representative for assistance.

Address of Principal Executive Offices

Address 1*	Address 2
Click here to enter text.	Click here to enter text.
(40 character limit)	(40 character limit)
City*	State/Country*	Mailing Zip/ Postal Code*
Click here to enter text.	Select	Click here to enter text.
(30 character limit)
Phone Number*
Click here to enter text.
(20 character limit. Hyphens may be included to improve readability.)

Provide the following information for the person the Securities and Exchange Commission’s staff should call in connection with any pre-qualification review of the offering statement

Name*
Click here to enter text.
(150 character limit)
Address 1*	Address 2
Click here to enter text.	Click here to enter text.
(40 character limit)	(40 character limit)
City*	State/Country*	Mailing Zip/ Postal Code*
Click here to enter text.	Select	Click here to enter text.
(30 character limit)
Phone Number*
Click here to enter text.
(20 character limit. Hyphens may be included to improve readability.)

Provide up to two e-mail addresses to which the Securities and Exchange Commission’s staff may send any comment letters relating to the offering statement. After qualification of the offering statement, such e-mail addresses are not required to remain active.

E-Mail Address*
Click here to enter text.
(add, or remove, items as needed - only the most recently added row will be removed)

Financial Statements

Industry Group	Select

Note:	An asterisk will appear in the table below (Balance Sheet and Income Statement Information) for each required value, depending on the Industry group selected above. Any fields that do not have an asterisk can be left blank. 0’s are allowed, must contain decimal placeholders (e.g. .00).

Use the financial statements for the most recent period contained in this offering statement to provide the following information about the issuer. The following table does not include all of the line items from the financial statements. Long Term Debt would include notes payable, bonds, mortgages, and similar obligations. To determine "Total Revenues" for all companies selecting "Other" for their industry group, refer to Article 5-03(b)(1) of Regulation S-X. For companies selecting "Insurance", refer to Article 7-04 of Regulation S-X for calculation of "Total Revenues" and paragraphs 5 and 7 of Article 7-04 for "Costs and Expenses Applicable to Revenues".

Balance Sheet Information

*	*	*
Required Industry Group
Cash and Cash Equivalents:	$	Click here to enter text.	B, I, O
Investment Securities:	$	Click here to enter text.	B, O
Total Investments:	$	Click here to enter text.	I
Accounts and Notes Receivables:	$	Click here to enter text.	O
Loans:	$	Click here to enter text.	B
Property, Plant and Equipment (PP&E):	$	Click here to enter text.	O
Property and Equipment:	$	Click here to enter text.	B, I
Total Assets:	$	Click here to enter text.	B, I, O
Accounts Payable and Accrued Liabilities:	$	Click here to enter text.	B, I, O
Policy Liabilities and Accruals:	$	Click here to enter text.	B
Deposits:	$	Click here to enter text.	I
Long Term Debt:	$	Click here to enter text.	B, I, O
Total Liabilities:	$	Click here to enter text.	B, I, O
Total Stockholders' Equity:	$	Click here to enter text.	B, I, O
Total Liabilities and Equity:	$	Click here to enter text.	B, I, O

Income Statement Information

Total Revenues:	$	Click here to enter text.	I, O
Total Interest Income:	$	Click here to enter text.	B
Costs and Expenses Applicable to Revenues:	$	Click here to enter text.	I, O
Total Interest Expenses:	$	Click here to enter text.	B
Depreciation and Amortization:	$	Click here to enter text.	B, I, O
Net Income:	$	Click here to enter text.	B, I, O
Earnings Per Share - Basic:	$	Click here to enter text.	B, I, O
Earnings Per Share - Diluted:	$	Click here to enter text.	B, I, O

Key:	*	B= Banking
*	I = Insurance
*	O = Other

Name of Auditor (if any):	Click here to enter text.
(150 character limit, required for Tier 2 offerings)

Outstanding Securities

Common Equity: Name of Class (if any):	Click here to enter text.
(30 character limit)
Common Equity: Units Outstanding:*	Click here to enter text.
(13 digit limit, a 0 value is allowed)
Common Equity: CUSIP (if any):	Click here to enter text.
(9 character limit)
Common Equity: Name of Trading Center or Quotation	Click here to enter text.
Medium (if any):	(50 character limit)

(add, or remove, items as needed - only the most recently added table will be removed)

Preferred Equity: Name of Class (if any):	Click here to enter text.
(30 character limit)
Preferred Equity: Units Outstanding:*	Click here to enter text.
(13 digit limit, a 0 value is allowed)
Preferred Equity: CUSIP (if any):	Click here to enter text.
(9 character limit)
Preferred Equity: Name of Trading Center or Quotation	Click here to enter text.
Medium (if any):	(50 character limit)

(add, or remove, items as needed - only the most recently added table will be removed)

Debt Securities: Name of Class (if any):	Click here to enter text.
(30 character limit)
Debt Securities: Units Outstanding:*	Click here to enter text.
(13 digit limit, a 0 value is allowed)
Debt Securities: CUSIP (if any):	Click here to enter text.
(9 character limit)
Debt Securities: Name of Trading Center or Quotation	Click here to enter text.
Medium (if any):	(50 character limit)

(add, or remove, items as needed - only the most recently added table will be removed)

Item 2. Issuer Eligibility

Check this box to certify that all of the following statements are true for the issuer(s):false

Organized under the laws of the United States or Canada, or any State, Province, Territory or possession thereof, or the District of Columbia.

Principal place of business is in the United States or Canada.

Not subject to section 13 or 15(d) of the Securities Exchange Act of 1934.

Not a development stage company that either (a) has no specific business plan or purpose, or (b) has indicated that its business plan is to merge with an unidentified company or companies.

Not an investment company registered or required to be registered under the Investment Company Act of 1940.

Not issuing fractional undivided interests in oil or gas rights, or a similar interest in other mineral rights.

Not issuing asset-backed securities as defined in Item 1101 (c) of Regulation AB.

Not, and has not been, subject to any order of the Commission entered pursuant to Section 12(j) of the Exchange Act (15 U.S.C. 78l(j)) within five years before the filing of this offering statement.

Has filed with the Commission all the reports it was required to file, if any, pursuant to Rule 257 during the two years immediately before the filing of the offering statement (or for such shorter period that the issuer was required to file such reports).

Item 3. Application of Rule 262

Check this box to certify that, as of the time of this filing, each person described in Rule 262 of Regulation A is either not disqualified under that rule or is disqualified but has received a waiver of such disqualification.*false

Check this box if “bad actor” disclosure under Rule 262(d) is provided in Part II of the offering statement.false

Item 4. Summary Information Regarding the Offering and Other Current or Proposed Offerings

Indicate whether you are conducting a Tier 1 or Tier 2 offering:*	Select
Indicate whether the financial statements have been audited:*	Select

Types of Securities Offered in this Offering Statement (select all that apply):*
Equity (common or preferred stock)
Debt
Option, warrant or other right to acquire another security
Security to be acquired upon exercise of option, warrant or other right to acquire security
Tenant-in-common securities
Other(describe):
Click here to enter text.

Does the issuer intend to offer the securities on a delayed or continuous basis pursuant to Rule 251(d)(3)?*	Select
Does the issuer intend this offering to last more than one year?*	Select
Does the issuer intend to price this offering after qualification pursuant to Rule 253(b)?*	Select
Will the issuer be conducting a best efforts offering?*	Select
Has the issuer used solicitation of interest communications in connection with the proposed offering?*	Select
Does the proposed offering involve the resale of securities by affiliates of the issuer?*	Select
Number of securities offered:*	Click here to enter text.
Number of securities of that class outstanding:	Click here to enter text.

The information called for by this item below may be omitted if undetermined at the time of filing or submission, except that if a price range has been included in the offering statement, the midpoint of that range must be used to respond. Please refer to Rule 251(a) for the definition of “aggregate offering price” or “aggregate sales” as used in this item. Please leave the field blank if undetermined at this time and include a zero if a particular item is not applicable to the offering.

Price per security:	$	Click here to enter text.
The portion of the aggregate offering price attributable to securities being offered on behalf of the issuer:*	$	Click here to enter text.
The portion of the aggregate offering price attributable to securities being offered on behalf of selling securityholders:*	$	Click here to enter text.
The portion of the aggregate offering price attributable to all the securities of the issuer sold pursuant to a qualified offering statement within the 12 months before the qualification of this offering statement:*	$	Click here to enter text.
The estimated portion of aggregate sales attributable to securities that may be sold pursuant to any other qualified offering statement concurrently with securities being sold under this offering statement:*	$	Click here to enter text.
Total (the sum of the aggregate offering price and aggregate sales in the four preceding paragraphs):*	$	Click here to enter text.
Note: No more than 20 characters may be entered in each field in this table (0000000000000.00 format), must contain decimal placeholders (e.g. .00). These fields cannot be blank, a zero value may be used if the value is undetermined. Price per security also allows 4 digits after the decimal.

Anticipated fees in connection with this offering and names of service providers.

Name of Service Provider (150 character limit)	Fees
Underwriters:	Click here to enter text.	$	Click here to enter text.
Sales Commissions:	Click here to enter text.	$	Click here to enter text.
Finders' Fees:	Click here to enter text.	$	Click here to enter text.
Audit:	Click here to enter text.	$	Click here to enter text.
Legal:	Click here to enter text.	$	Click here to enter text.
Promoters:	Click here to enter text.	$	Click here to enter text.
Blue Sky Compliance:	Click here to enter text.	$	Click here to enter text.
CRD Number of any broker or dealer listed:	Click here to enter text.
Estimated net proceeds to the issuer:	Click here to enter text.
Clarification of responses (if necessary):
Click here to enter text.
(255 character limit)

Item 5. Jurisdictions in Which Securities are to be Offered

Click the “Select Jurisdictions” button to select the jurisdictions in which the issuer intends to offer the securities:

Note:	Use the Select Jurisdictions button to add or remove items.

Selected jurisdictions in which the issuer intends to offer the securities:

Selected jurisdictions in which the securities are to be offered by underwriters, dealers or sales persons:

Nonefalse
Same as the jurisdictions in which the issuer intends to offer the securitiesfalse

Item 6. Unregistered Securities Issued or Sold Within One Year

false	None

As to any unregistered securities issued by the issuer of any of its predecessors or affiliated issuers within one year before the filing of this Form 1-A, state:

(a)	Name of such issuer:(1)	Click here to enter text.
(150 character limit)
(b)	(1)	Title of securities issued:(1)	Click here to enter text.
(255 character limit)
(2)	Total Amount of such securities issued:(1)	Click here to enter text.
(13 digit limit)
(3)	Amount of such securities sold by or for the account of any	Click here to enter text.
person who at the time was a director, officer, promoter or principal security holder of the issuer of such securities, or was an underwriter of any securities of such issuer:(1)	(13 digit limit)
(c)	(1)	Aggregate consideration for which the securities were issued and basis for computing the amount thereof:(1)
Click here to enter text.
(2000 character limit)
(2)	Aggregate consideration for which the securities listed in (b)(3) of this item (if any) were issued and the basis for computing the amount thereof (if different from the basis described in (c)(1)):(1)
Click here to enter text.
(2000 character limit)

(add, or remove, items as needed - only the most recently added table will be removed)

(1)	Required if None is unchecked.

(d)	Indicate the section of the Securities Act or Commission rule or regulation relied upon for exemption from the registration requirements of such Act and state briefly the facts relied upon for such exemption:
Click here to enter text.
(250 character limit)