Proxy

PROXY I do hereby constitute, make, and appoint (name) of (address) my true and lawful attorney with full power of substitution, for me and in my name, place and stead, to vote at the , Inc. shareholders' meeting at (location) or at any adjournment thereof or at any special meeting of , Inc. thereafter, during the period of twelve months from the date hereof, for the election of directors and for the transaction of such other business as may properly come before said meeting, according to the number of votes I would be entitled to cast if personally present. Witness my hand this day of , . Signature American LegalNet, Inc. 251 www.FormsWorkFlow.com