FOR VALUE RECEIVED,
the undersigned hereby sells, assigns and transfers to
_____________________________the following shares of the stock of
_________________________ (the "Corporation") standing in the name of the
undersigned on the books of the Corporation and represented by the following
Certificate No (s).:
NUMBER OF SHARES CERTIFICATE NO (S).
_________ ____________________
_________ ____________________
_________ ____________________
The undersigned
hereby and irrevocably constitutes and appoints
________________________________ as his attorney to transfer the said stock on
the books of the Corporation with full power of substitution in the premises.
Dated this_____ day of_________________, 200(X).
______________________ _______________________
Macrotwin Company / www.FreeBusinessForms.com