Confidentiality Agreement Note:   Since the additional information you have requested is of a confidential and/or proprietary nature, please complete and print the "Confidentiality Agreement" below, then sign and fax a copy to (714)-701-0300. Upon receipt we will be happy to provide any additional information requested. Thank you. Registration and Confidentiality Agreement Gentlemen: In consideration of the information furnished to me concerning the businesses listed below as being available for sale or lease, I agree that should I buy, lease, rent, manage or otherwise come into possession of any of them within two (2) years from the date herein, that I will deal and purchase through your office, so that you may collect your commission from the Seller, as provided for in the Listing Contract. In the event that I should buy, lease, rent, manage or otherwise come into possession of any of the businesses listed below without dealing through your office, I will pay you a commission of twelve per cent (12%) of the total purchase price or twelve thousand ($12,000.00) dollars whichever is greater. It is agreed that if I make the purchase through your office, I am not liable for a commission. All proprietary information furnished by the Broker or the companies to you will be deemed confidential, with the exception of information which becomes generally available to the public or is already in your possession. Unless we otherwise agree in writing, you agree not to disclose or reveal any proprietary information for a period of five years from the date herein, to any persons or   entities other than your employees or your representatives actively and directly participating in the evaluation of the proprietary information. It is understood and agreed that I will not talk to any of the owners or employees of the companies without approval in advance from the Broker. Although you understand that the Broker will include in the proprietary information certain information which we believe to be reliable and consider to be relevant for the purpose of your investigation of any proposed transaction, we do not make any representations or warranties as to it's accuracy or completeness. I understand that it shall be my sole responsibility to investigate the accuracy of all information provided.   First Name:   Last Name:   Address:   City:   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming   Zip Code:   E-Mail:   Business Phone:   Fax:   Home/Cell Phone:   (Please enter a profile number and/or description for each business you are interested in) Remember to sign this document and fax a copy to (714)-701-0300     ___________________________________________ Signature                 _________________________ Date