General Form 1-Z Electronic Worksheet Instructions and Information

The following information must be provided for the XML-based portion of Form 1-Z 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-Z and Instructions: http://www.sec.gov/about/forms/form1-z.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)
Is this filing by a successor company pursuant to Rule 257(b)(5) resulting from a merger or other business combination?	Choose an item.
If yes, enter the applicable File Number:	24R-Click here to enter text.
File Number (Required for 1-Z/A)	24R-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 (if any)
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.

Preliminary 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.)

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.)

Commission File Number(s)*
024-Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)

Part I - Summary Information Regarding the Offering and Proceeds

Date of qualification of the offering statement:	Click here to enter date.
(MM-DD-YYYY)
Date of commencement of the offering:	Click here to enter date.
(MM-DD-YYYY)
Amount of securities qualified to be sold in the offering:	Click here to enter text.
Amount of securities sold in the offering:	Click here to enter text.
Price per security: (if not applicable, leave blank)	$	Click here to enter text.
The portion of aggregate sales attributable to securities sold on behalf of the issuer:	$	Click here to enter text.
The portion of the aggregate sales attributable to securities sold on behalf of selling securityholders:	$	Click here to enter text.
Fees in connection with this offering and names of service providers
Name of Service Provider	Fees
Underwriters: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Sales Commissions: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Finders' Fees: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Audit: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Legal: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Promoters: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Sky Compliance: Click here to enter text.	$	Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
CRD Number of any broker or dealer listed:	Click here to enter text.
Net proceeds to the issuer:	$	Click here to enter text.
Clarification of responses (if necessary):
Click here to enter text.
(255 character limit)

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

Part II - Certification of Suspension of Duty to File Reports

Title of each class of securities covered by this Form:
Click here to enter text.
Commission File Number(s):*
024-Click here to enter text.
(add, or remove, items as needed - only the most recently added item will be removed)
Approximate number of holders of record as of the certification date:
Click here to enter text.

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

Signature

Pursuant to the requirements of Regulation A,
CIK:*	Click here to enter text.
Name of issuer as specified in charter:*	Click here to enter text.
(Note: This field must match the EDGAR profile on file with the SEC.)
certifies that it meets all of the conditions for termination of Regulation A reporting specified in Rule 257(d) and that there are no classes of securities other than those that are the subject to this Form 1-Z regarding which the issuer has Regulation A reporting obligations.
Name of issuer as specified in charter:*	Click here to enter text.
(Note: This field must match the EDGAR profile on file with the SEC.)
Has caused this certification to be signed on its behalf by the undersigned duly authorized person.
By:*	Click here to enter text.
Date:*	Click here to enter date.
Title:*	Click here to enter text.
Instructions: This Part II of Form 1-Z is required by Rule 257(d) of Regulation A. An officer of the issuer or any other duly authorized person may sign, and must do so by typed signature. The name and title of the person signing the form must be typed or printed under the signature. The signatory to the filing must also manually sign a signature page or other document authenticating, acknowledging or otherwise adopting his or her signature that appears in the filing. Such document must be executed before or at the time the filing is made and must be retained by the issuer for a period of five years. Upon request, the issuer must furnish to the Commission or its staff a copy of any or all documents retained pursuant to this instruction.

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

Note:	You must include a signature table for each Issuer included in the filing. Click to add additional tables.