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EXHIBIT "C" TO

AUTHORIZATION TO SELL AND OWNER?S STATEMENT

 

PROSPECT REGISTRATION AND AUTHORIZATION

TO RELEASE INFORMATION AGREEMENT


WHEREAS, Broker has secured a certain prospective purchaser who has expressed an interest in the subject Business; and,

WHEREAS, Broker has qualified said prospective purchaser, to the best of Broker?s ability, and determined purchaser to be financially able to purchase the subject Business; and,

WHEREAS, said purchaser has fully executed the Confidentiality Agreement as prescribed in the above referenced principal Agreement.

Broker seeks hereby to register this certain prospective Purchaser with Seller and seek Seller?s authorization to release to said Purchaser specific and confidential information relating to the subject Business.

The prospective Purchaser is identified as follows:

Last name: ___________________________________

Numerical portion of street address:_______________________________

Last four digits of phone number:___________________________

Zip code:__________________________________

By executing this Exhibit in the space provided below, Seller hereby accepts this prospect as a registered prospect of Broker and authorizes Broker to release any and all information in its possession regarding the subject Business to this prospect.

EXECUTED this _____________ day of ______________________, 2010:

SELLER:

By:________________________________

Title:______________________________