ARIZONA CORPORATION COMMISSION - REG 506 FORM D
Pursuant to A.R.S. § 44-1843.02(C), Issuers of securities that are described as covered securities in section 18(b)(4)(D) of the securities act of 1933 shall file with the commission not later than fifteen calendar days after the first sale of securities in or from this state one copy of a notice on form D. The notice on form D shall contain a manual or facsimile signature of a person duly authorized by the issuer and is considered filed with the commission on receipt at the commission's Phoenix office or as of the date on which the notice is mailed by United States registered or certified mail to the commission's Phoenix office if the notice is delivered to that office after the date on which the notice is required to be filed. The issuer shall pay the initial filing fee prescribed in section 44-1861, subsection E.

IMPORTANT
Your Initial Reg 506 Form D filing is only effective upon completing this form and the Division's receipt of the required filing fee. Complete this process for Each separate Reg 506 Form D filing.

Are you an Issuer (or Issuer's agent) submitting a New initial Reg 506 Form D filing with the State of Arizona? If filing an amendment to a previously filed Form D, please click No.