Pursuant to §55-4-02 or §55A-4-02 of the General Statutes of North Carolina, the undersigned hereby applies to the Secretary of State to reserve the following corporate name:

1. The corporate name to be reserved is: ___________________________________________

2. The name of the applicant is: __________________________________________________

3. The address of the applicant is:

Street Address ______________________________________________________________

City, State, Zip Code ________________________________________________________

4. The above corporate name is to be reserved for a nonrenewable period of 120 days from the date of the filing of this application.

This is the day of , 19___

_____________________________________________

_____________________________________________

Signature

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Type or Print Name and Title

NOTES:

1. Filing fee is $10. This document and one exact copy of this application must be filed with the Secretary of State.