Logged In: FRN[frn] (Log Out)

Auction [auction id]

Ownership
Detail for Disclosable Interest Holder: [Name]

Disclosable Interest Holder Type and Name Edit -
Disclosable Interest Holder Name:		[Entity or Individual Name]
Entity Type:		[Entity Type]
FRN:		[FRN]
Disclosable Interest Holder Address
Address:		[Address]
Address2:		[Address2]
City:		[City]
[State:]		[State]
[Zip Code:]		[Zip Code]
[Postal Code:]		[Postal Code]
[Country:]		[Country]
Type of Interest in Applicant
[Direct Ownership Interest in Applicant]
[Indirect Ownership Interest in Applicant]
[Officer]
[Director]
[Key Management Personnel]
[Management Contract]
[Other] [Other Description]
Type of Ownership Interest in Applicant
[Common Stock:] [Type]
[General Partnership Shares:] [Type]
[Limited Partnership Shares:] [Type]
[Membership Shares]
[Option to Acquire Equity]
[Proprietorship]
[Preferred Stock] [Type]
[Warrant]
[Other] [Other Description]
Disclosable Interest Held in Applicant
Percent of Interest Held in Applicant:		[##] %
Country of Citizenship or Jurisdiction of Formation:		[Country/Jurisdiction]
Financial Statements
[[Disclosable Interest Holder name] used audited financial statements.]
[[Disclosable Interest Holder name] used unaudited financial statements prepared in accordance with Generally Accepted Accounting Principles and certified by their chief financial officer.]
Gross Revenues Attributable to Applicant
Gross Revenues for
	Most recent reportable year:	$[Revenues] [year end date]
	One year prior to most recent reportable year:	$[Revenues] [year end date]
	Two years prior to most recent reportable year:	$[Revenues] [year end date]
	Average Gross Revenues:	$[Avg. Revenues]