The undersigned hereby applies for appointment as an associate of American Business Brokers Applicant hereby authorizes us to investigate and verify all statements made, including checking with all persons and entities associated with applicant whether named in this application or not. This may include investigation into the status of real estate and broker's licenses, records, credit, character, financial stability, criminal and civil matters, driving record and court filings. This application shall be deemed an authorization of all such persons contacted to provide any information we request and you waive any right, or cause of action against any party arising out of statements made by any party named herein who supplies us information. It is agreed falsification is grounds for termination.

If applicant is a partnership, each partner must complete a separate application. If applicant is a corporation, each shareholder, officer, director, and the principal broker must complete a separate application

I submit the foregoing information and/or attached statement as my complete and true personal and financial condition as of the date shown below. In accordance with the Privacy Act (5 U.S.C.552a), Freedom of Information Act and The Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency, federal, state or local, or any person who has personal knowledge of my character, work experience or criminal record to release this information to American Business Brokers.

If requested I agree to supply statements from my professional advisors verifying the above assets and I give permission to have said persons supply any relevant information. I also agree to furnish copies of Federal Income Tax Returns as filed, if requested. I understand that you are relying upon all the above information as a material factor in considering my application to become an associate, and I release all persons from liability as a result of true, accurate information.