By returning this form by fax, by e-mail or by mail, I acknowledge and agree to the following:

1. I hereby certify that Delaware Corporations LLC has not provided me any legal or tax services or advice.

2.The initial member(s) hereby appoint Delaware Corporations LLC as an authorized person to execute the certificate of formation for the limited liability company to be formed pursuant to this order form.

3. If this form is returned by e-mail and not by fax or by mail, then the act of returning this form by e-mail shall constitute the execution by me of this form with like effect as if I had manually signed this form below in the space provided for my signature.

Signature (if sending by fax or mail):

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