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    <title>Disclaimer - Law Firm Finger & Finger, A Professional Corporation Attorneys White
        Plains, New York</title>
    <meta name="keywords" content="Motor Vehicle Accidents -- Plaintiff Personal Injury -- Plaintiff Real Estate Law Social Security -- Disability Workers' Compensation Law">
    <meta name="description" content="The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your - Finger &amp; Finger, A Professional Corporation White Plains, New York">
    <meta name="submittime" content="4/14/2006 2:22:48 PM">
    <meta name="pubdate" content="10/18/2005 12:00:00 AM">
    <meta name="contenttype" content="Custom">
    <meta name="PageType" content="Disclaimer">
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    <script language="JavaScript" src="Includes/clientcode/formValidation.js" type="text/javascript"></script>

    <style type="text/css">
        <!
        -- .style1
        {
            color: #990000;
            font-weight: bold;
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        -- ></style>

    <script language="javascript" type="text/javascript">
        function checkForm() {
            if (!hasValue(document.getElementById("currentDate"), 2)) {
                alert("Please enter a date");
                document.getElementById("currentDate").focus();
                return false;
            }

            if (!isDate(document.getElementById("currentDate").value)) {
                document.getElementById("currentDate").focus();
                return false;
            }

           if (!hasValue(document.getElementById("cooperative"), 2)) {
           
                alert("Please enter a cooperative");
                document.getElementById("cooperative").focus();
                return false;
            }

            if (!hasValue(document.getElementById("seller"), 2)) {
                alert("Please enter a seller");
                document.getElementById("seller").focus();
                return false;
            }

            if (!hasValue(document.getElementById("sellerAptNo"), 2)) {
                alert("Please enter a Seller Apt No.");
                document.getElementById("sellerAptNo").focus();
                return false;
            }


            //if (!hasValue(document.getElementById("sellerAddress"), 2)) {
            if (document.getElementById("sellerAddress").selectedIndex == 0) {
                alert("Please enter a seller Address");
                document.getElementById("sellerAddress").focus();
                return false;
            }

            if (!hasValue(document.getElementById("sellerCity"), 2)) {
                alert("Please enter a Seller City");
                document.getElementById("sellerCity").focus();
                return false;
            }

            if (!hasValue(document.getElementById("sellerState"), 2)) {
                alert("Please enter a Seller State");
                document.getElementById("sellerState").focus();
                return false;
            }


            if (!hasValue(document.getElementById("sellerZip"), 2)) {
                alert("Please enter a Seller Zip");
                document.getElementById("sellerZip").focus();
                return false;
            }

            if (!hasValue(document.getElementById("noShares"), 1)) {
                alert("Please enter a No. Shares");
                document.getElementById("noShares").focus();
                return false;
            }

            if (!isInteger(document.getElementById("noShares").value)) {
                alert("Please enter only numbers in the No. Shares");
                document.getElementById("noShares").focus();
                return false;
            }

            if (!hasValue(document.getElementById("proprietaryLeaseDate"), 2)) {
                alert("Please enter a Proprietary Lease Date");
                document.getElementById("proprietaryLeaseDate").focus();
                return false;
            }

            if (!isDate(document.getElementById("proprietaryLeaseDate").value)) {
                document.getElementById("proprietaryLeaseDate").focus();
                return false;
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            if (!hasValue(document.getElementById("sellerAttorney"), 2)) {
                alert("Please enter a Seller Attorney");
                document.getElementById("sellerAttorney").focus();
                return false;
            }

            if (!hasValue(document.getElementById("sellerAttorneyEmail"), 2)) {
                alert("Please enter a Seller Attorney Email");
                document.getElementById("sellerAttorneyEmail").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("sellerAttorneyEmail").value, "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzfSOZsozY�������������������������������������������������������������0123456789--_@. \t\r\n\f")) {
                alert("Please enter only letter, digit, whitespace and \"-_@.\" characters in the \"Seller Attorney Email Address\" field.");
                document.getElementById("sellerAttorneyEmail").focus();
                return false;
            }

            if (!hasCharacter(document.getElementById("sellerAttorneyEmail").value, "@")) {
                alert("There must be an \"@\" in Seller Attorney Email");
                document.getElementById("sellerAttorneyEmail").focus();
                return false;
            }

            if (!hasCharacter(document.getElementById("sellerAttorneyEmail").value, ".")) {
                alert("There must be an \".\" in Seller Attorney Email");
                document.getElementById("sellerAttorneyEmail").focus();
                return false;
            }

            if (document.getElementById("sellerAttorneyPhone").value.search(/\d{3}\-\d{3}\-\d{4}/) == -1) {
                alert("The Seller Attorney Phone number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
                document.getElementById("sellerAttorneyPhone").focus();
                return false;
            }


            if (!hasValue(document.getElementById("sellerAttorneyPhone"), 10)) {
                alert("Please enter 10 number for Seller Attorney Phone");
                document.getElementById("sellerAttorneyPhone").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("sellerAttorneyPhone").value, "0123456789-")) {
                alert("Please enter only numbers and \"-\" in the \"Seller Attorney Phone\" field.");
                document.getElementById("sellerAttorneyPhone").focus();
                return false;
            }

            if (document.getElementById("sellerAttorneyFax").value.search(/\d{3}\-\d{3}\-\d{4}/) == -1) {
                alert("The Seller Attorney Fax number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
                document.getElementById("sellerAttorneyFax").focus();
                return false;
            }

            if (!hasValue(document.getElementById("sellerAttorneyFax"), 10)) {
                alert("Please enter 10 number for Seller Attorney Fax");
                document.getElementById("sellerAttorneyFax").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("sellerAttorneyFax").value, "0123456789-")) {
                alert("Please enter only numbers and \"-\" in the \"Seller Attorney Fax\" field.");
                document.getElementById("sellerAttorneyFax").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaser"), 2)) {
                alert("Please enter a Purchaser");
                document.getElementById("purchaser").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserAddress"), 2)) {
                alert("Please enter a Purchaser Address");
                document.getElementById("purchaserAddress").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserCity"), 2)) {
                alert("Please enter a Purchaser City");
                document.getElementById("purchaserCity").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserState"), 2)) {
                alert("Please enter a Purchaser State");
                document.getElementById("purchaserState").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserZip"), 2)) {
                alert("Please enter a Purchaser Zip");
                document.getElementById("purchaserZip").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserAttorney"), 2)) {
                alert("Please enter a Purchaser Attorney");
                document.getElementById("purchaserAttorney").focus();
                return false;
            }



            if (!hasValue(document.getElementById("purchaserAttorneyEmail"), 2)) {
                alert("Please enter a Purchaser Attorney Email");
                document.getElementById("purchaserAttorneyEmail").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("purchaserAttorneyEmail").value, "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzfSOZsozY�������������������������������������������������������������0123456789--_@. \t\r\n\f")) {
                alert("Please enter only letter, digit, whitespace and \"-_@.\" characters in the \"Purchaser Attorney Email Address\" field.");
                document.getElementById("purchaserAttorneyEmail").focus();
                return false;
            }

            if (!hasCharacter(document.getElementById("purchaserAttorneyEmail").value, "@")) {
                alert("There must be an \"@\" in Purchaser Attorney Email");
                document.getElementById("purchaserAttorneyEmail").focus();
                return false;
            }

            if (!hasCharacter(document.getElementById("purchaserAttorneyEmail").value, ".")) {
                alert("There must be an \".\" in Purchaser Attorney Email");
                document.getElementById("purchaserAttorneyEmail").focus();
                return false;
            }

            if (document.getElementById("purchaserAttorneyPhone").value.search(/\d{3}\-\d{3}\-\d{4}/) == -1) {
                alert("The Purchaser Attorney Phone number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
                document.getElementById("purchaserAttorneyPhone").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserAttorneyPhone"), 10)) {
                alert("Please enter 10 number for Purchaser Attorney Phone");
                document.getElementById("purchaserAttorneyPhone").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("purchaserAttorneyPhone").value, "0123456789-")) {
                alert("Please enter only numbers and \"-\" in the \"Purchaser Attorney Phone\" field.");
                document.getElementById("purchaserAttorneyPhone").focus();
                return false;
            }

            if (document.getElementById("purchaserAttorneyFax").value.search(/\d{3}\-\d{3}\-\d{4}/) == -1) {
                alert("The Purchaser Attorney Fax number you entered is not valid.\r\nPlease enter a phone number with the format xxx-xxx-xxxx.");
                document.getElementById("purchaserAttorneyFax").focus();
                return false;
            }

            if (!hasValue(document.getElementById("purchaserAttorneyFax"), 10)) {
                alert("Please enter 10 number for Purchaser Attorney Fax");
                document.getElementById("purchaserAttorneyFax").focus();
                return false;
            }

            if (!isValidCharacters(document.getElementById("purchaserAttorneyFax").value, "0123456789-")) {
                alert("Please enter only numbers and \"-\" in the \"Purchaser Attorney Fax\" field.");
                document.getElementById("purchaserAttorneyFax").focus();
                return false;
            }

            if (!hasValue(document.getElementById("dateBoardApproved"), 2)) {
                alert("Please enter Date Board Approved");
                document.getElementById("dateBoardApproved").focus();
                return false;
            }

            if (!isDate(document.getElementById("dateBoardApproved").value)) {
                document.getElementById("dateBoardApproved").focus();
                return false;
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            return true;
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        function hasValue(obj, strLength) {
            if (obj.value.length < strLength) {
                return false;
            }
            else {
                return true;
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        function isValidCharacters(checkStr, checkOK) {

            var allValid = true;
            for (i = 0; i < checkStr.length; i++) {
                ch = checkStr.charAt(i);
                for (j = 0; j < checkOK.length; j++)
                    if (ch == checkOK.charAt(j))
                    break;
                if (j == checkOK.length) {
                    allValid = false;
                    break;
                }
            }

            return allValid;

        }

        function hasCharacter(checkStr, character) {

            var isFound = false;
            for (i = 0; i < checkStr.length; i++) {
                ch = checkStr.charAt(i);
                if (ch == character)
                    isFound = true

            }

            return isFound;
        }


        var dtCh = "/";
        var minYear = 1900;
        var maxYear = 2100;

        function isInteger(s) {
            var i;
            for (i = 0; i < s.length; i++) {
                // Check that current character is number.
                var c = s.charAt(i);
                if (((c < "0") || (c > "9"))) return false;
            }
            // All characters are numbers.
            return true;
        }

        function stripCharsInBag(s, bag) {
            var i;
            var returnString = "";
            // Search through string's characters one by one.
            // If character is not in bag, append to returnString.
            for (i = 0; i < s.length; i++) {
                var c = s.charAt(i);
                if (bag.indexOf(c) == -1) returnString += c;
            }
            return returnString;
        }

        function daysInFebruary(year) {
            // February has 29 days in any year evenly divisible by four,
            // EXCEPT for centurial years which are not also divisible by 400.
            return (((year % 4 == 0) && ((!(year % 100 == 0)) || (year % 400 == 0))) ? 29 : 28);
        }
        function DaysArray(n) {
            for (var i = 1; i <= n; i++) {
                this[i] = 31
                if (i == 4 || i == 6 || i == 9 || i == 11) { this[i] = 30 }
                if (i == 2) { this[i] = 29 }
            }
            return this
        }

        function isDate(dtStr) {
            var daysInMonth = DaysArray(12)
            var pos1 = dtStr.indexOf(dtCh)
            var pos2 = dtStr.indexOf(dtCh, pos1 + 1)
            var strMonth = dtStr.substring(0, pos1)
            var strDay = dtStr.substring(pos1 + 1, pos2)
            var strYear = dtStr.substring(pos2 + 1)
            strYr = strYear
            if (strDay.charAt(0) == "0" && strDay.length > 1) strDay = strDay.substring(1)
            if (strMonth.charAt(0) == "0" && strMonth.length > 1) strMonth = strMonth.substring(1)
            for (var i = 1; i <= 3; i++) {
                if (strYr.charAt(0) == "0" && strYr.length > 1) strYr = strYr.substring(1)
            }
            month = parseInt(strMonth)
            day = parseInt(strDay)
            year = parseInt(strYr)
            if (pos1 == -1 || pos2 == -1 || pos1 != 2 || pos2 != 5) {
                alert("The date format should be : mm/dd/yyyy")
                return false
            }
            if (strMonth.length < 1 || month < 1 || month > 12) {
                alert("Please enter a valid month")
                return false
            }
            if (strDay.length < 1 || day < 1 || day > 31 || (month == 2 && day > daysInFebruary(year)) || day > daysInMonth[month]) {
                alert("Please enter a valid day")
                return false
            }
            if (strYear.length != 4 || year == 0 || year < minYear || year > maxYear) {
                alert("Please enter a valid 4 digit year between " + minYear + " and " + maxYear)
                return false
            }
            if (dtStr.indexOf(dtCh, pos2 + 1) != -1 || isInteger(stripCharsInBag(dtStr, dtCh)) == false) {
                alert("Please enter a valid date")
                return false
            }
            return true
        }

 

	
    </script>

</head>
<body class="design">
    <!-- ### Start Container ### -->
    <div id="container">
        <!-- ### Start Banner ### -->
        <div id="banner">
            <div id="navigation">
                <!-- ### Start Integration - Navigation ### -->
                <a href="index.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('nav-home','','images/nav-home-o.gif',1)">
                    <img name="nav-home" src="images/nav-home.gif" width="52" height="22" border="0"
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                                                                    name="nav-cont" src="images/nav-cont.gif" width="92" height="22" border="0" alt="Contact Us"></a><span
                                                                        class="navigation-forms"><a href="SecuredContent/Forms5.html" onmouseout="MM_swapImgRestore()"
                                                                            onmouseover="MM_swapImage('nav-forms','','images/nav-forms-o.gif',1)"><img name="nav-forms"
                                                                                src="images/nav-forms.gif" width="88" height="22" border="0" alt="Forms"></a></span><br />
                <!-- ### End Integration - Navigation ### -->
            </div>
            <p id="firmAddress">
                158 Grand Street &bull; White Plains, New York &bull; 10601</p>
            <img src="images/phoneNo.gif" alt="Phone number: (914)949-0308" width="223" height="59" /><a
                href="Contact.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('emailUs','','images/emailUs-o.gif',0)"><img
                    src="images/emailUs.gif" alt="Email Us" name="emailUs" width="104" height="59"
                    border="0" id="emailUs" /></a><br />
            <a href="index.html">
                <img src="images/firmName.gif" alt="Finger &amp; Finger. A Professional Corporation"
                    width="436" height="233" border="0" longdesc="../../index.html" /></a><img src="images/bannerPhoto.jpg"
                        alt="" width="340" height="233" /><br />
        </div>
        <!-- ### End Banner ### -->
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        <div id="body">
            <!-- ### Start Main Panel ### -->
            <div id="mainPanel">
                <div id="content">
                    <h1>
                        Closings</h1>
                    <p>
                        Thank you for using our website for the closing about which you have inquired. Using
                        the website will facilitate and expedite the closing. Please fill out the form below
                        carefully and correctly. You must fill out the Seller’s name as it appears on the
                        stock certificate. You must fill out the Cooperative as it appears on the stock
                        certificate. Upon completion please click the submit button. You will receive an
                        email confirming that the closing process has commenced and thereafter you will
                        receive a subsequent email directing providing you with a code and webpage to obtain
                        the closing costs.</p>
                    <form name="form1" method="post" action="saveCoopClosing.aspx" onsubmit="return checkForm();">
                    <table width="90%" border="0" cellspacing="0" cellpadding="3">
                        <tr>
                            <td width="37%" align="right" valign="top">
                                Date<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <label>
                                    <input name="currentDate" type="text" id="currentDate" size="25">
                                </label>
                            </td>
                            <td align="left" style="font-size: xx-small">
                                mm/dd/yyyy
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Cooperative Name<br>
                            </td>
                            <td align="left" valign="top">
                            <input name="cooperative" type="text" id="cooperative" size="25">
                                
                            </td>
                            <td align="left" style="font-size: xx-small" valign="top">
                                (exactly as it appears on stock certificate)
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller<br>
                            </td>
                            <td align="left" valign="top">
                                <input name="seller" type="text" id="seller" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                (exactly as it appears on stock certificate)
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Apt. No.<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerAptNo" type="text" id="sellerAptNo" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Street Address<br>
                            </td>
                            <td align="left" valign="top" colspan="2">                                
                                <select name="sellerAddress" id="sellerAddress">
                                    <option></option>
                                    <option>180 East Hartsdale Avenue</option>
                                    <option>210 Pelham Road</option>
                                    <option>220 Pelham Road</option>
                                    <option>230 Pelham Road</option>
                                    <option>445 Broadway </option>
                                    <option>470 Halstead Avenue</option>
                                    <option>480 Halstead Avenue</option>
                                    <option>472 Gramatan Avenue</option>
                                    <option>11 Alden Road</option>
                                    <option>10 Nosband Avenue</option>
                                    <option>143 Bruce Avenue</option>
                                    <option>2 Channing Place</option>
                                    <option>4 Channing Place</option>
                                    <option>6 Channing Place</option>
                                    <option>8 Channing Place</option>
                                    <option>10 Channing Place</option>
                                    <option>12 Channing Place</option>
                                    <option>14 Channing Place</option>
                                    <option>16 Channing Place</option>
                                    <option>18 Channing Place</option>
                                    <option>20 Channing Place</option>
                                    <option>22 Channing Place</option>
                                    <option>24 Channing Place</option>
                                    <option>26 Channing Place</option>
                                    <option>1840 Crompond Road</option>
                                    <option>754 Bronx River Road</option>
                                    <option>760 Bronx River Road</option>
                                    <option>766 Bronx River Road</option>
                                    <option>770 Bronx River Road</option>
                                    <option>776 Bronx River Road</option>
                                    <option>780 Bronx River Road</option>
                                    <option>786 Bronx River Road</option>
                                    <option>790 Bronx River Road</option>
                                    <option>796 Bronx River Road</option>
                                    <option>800 Bronx River Road</option>
                                    <option>25 Franklin Avenue</option>
                                    <option>Hilltop Acres</option>
                                    <option>80 East Hartsdale Avenue</option>
                                    <option>632 Warburton Avenue</option>
                                    <option>650 Warburton Avenue</option>
                                    <option>678 Warburton Avenue</option>
                                    <option>222 Martling Avenue</option>
                                    <!--option>5 Oakdale Manor</option-->
                                    <option>1428 Midland Avenue</option>
                                    <option>1430 Midland Avenue</option>
                                    <option>1910 Pelham Parkway South</option>
                                    <option>30 South Cole Avenue</option>
                                    <option>40 South Cole Avenue</option>
                                    <option>1 David Lane</option>
                                    <option>3 David Lane</option>
                                    <option>177 East Hartsdale Avenue</option>
                                    <option>Peck Avenue</option>
                                    <option>155 Ferris Avenue</option>
                                    <option>10 North Broadway</option>
                                    <option>98 Pearsall Drive</option>
                                    <option>104 Pearsall Drive</option>
                                    <option>110 Pearsall Drive</option>
                                    <option>154 Pearsall Drive</option>
                                    <option>161 Pearsall Drive</option>
                                    <option>171 Pearsall Drive</option>
                                    <option>180 Pearsall Drive</option>
                                    <option>181 Pearsall Drive</option>
                                    <option>19 Maple Avenue</option>
                                    <option>21 Maple Avenue</option>
                                    <option>23 Maple Avenue</option>
                                    <option>25 Maple Avenue</option>
                                    <option>27 Maple Avenue</option>
                                    <option>29 Maple Avenue</option>
                                    <option>31 Maple Avenue</option>
                                    <option>33 Maple Avenue</option>
                                    <option>35 Maple Avenue</option>
                                    <option>37 Maple Avenue</option>
                                    <option>39 Maple Avenue</option>
                                    <option>41 Maple Avenue</option>
                                    <option>43 Maple Avenue</option>
                                    <option>45 Maple Avenue</option>
                                    <option>47 Maple Avenue</option>
                                    <option>49 Maple Avenue</option>
                                    <option>51 Maple Avenue</option>
                                    <option>53 Maple Avenue</option>
                                    <option>55 Maple Avenue</option>
                                    <option>57 Maple Avenue</option>
                                    <option>59 Maple Avenue</option>
                                    <option>61 Maple Avenue</option>
                                     <option>30 Clinton Place</option>
                                    <option>309 North Broadway</option>
                                </select>
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller City<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerCity" type="text" id="sellerCity" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller State<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerState" type="text" id="sellerState" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Zip<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerZip" type="text" id="sellerZip" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                No. Shares<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="noShares" type="text" id="noShares" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Proprietary Lease Date<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="proprietaryLeaseDate" type="text" id="proprietaryLeaseDate" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                mm/dd/yyyy
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Attorney<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerAttorney" type="text" id="sellerAttorney" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Attorney Email<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="sellerAttorneyEmail" type="text" id="sellerAttorneyEmail" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Attorney Phone Number<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="sellerAttorneyPhone" type="text" id="sellerAttorneyPhone" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                XXX-XXX-XXXX
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Seller Attorney Fax Number<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="sellerAttorneyFax" type="text" id="sellerAttorneyFax" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                XXX-XXX-XXXX
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser<br>
                            </td>
                            <td align="left" valign="top">
                                <input name="purchaser" type="text" id="purchaser" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                (exactly as you would like it to appear on the stock certificate)
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Street Address<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserAddress" type="text" id="purchaserAddress" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser City<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserCity" type="text" id="purchaserCity" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser State<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserState" type="text" id="purchaserState" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Zip<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserZip" type="text" id="purchaserZip" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Attorney<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserAttorney" type="text" id="purchaserAttorney" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Attorney Email<br>
                            </td>
                            <td align="left" valign="top" colspan="2">
                                <input name="purchaserAttorneyEmail" type="text" id="purchaserAttorneyEmail" size="25">
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Attorney
                                <br>
                                Phone Number<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="purchaserAttorneyPhone" type="text" id="purchaserAttorneyPhone" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                XXX-XXX-XXXX
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Purchaser Attorney<br>
                                Fax Number<br>
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="purchaserAttorneyFax" type="text" id="purchaserAttorneyFax" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                XXX-XXX-XXXX
                            </td>
                        </tr>
                        <tr>
                            <td align="right" valign="top">
                                Date Board Approved
                            </td>
                            <td align="left" valign="top" colspan="1">
                                <input name="dateBoardApproved" type="text" id="dateBoardApproved" size="25">
                            </td>
                            <td align="left" style="font-size: xx-small">
                                mm/dd/yy
                            </td>
                        </tr>
                        <tr>
                            <td colspan="3" align="left">
                                <br />
                                Please confirm that the above information is complete and accurate by clicking on
                                the “submit” button below.<br />
                            </td>
                        </tr>
                        <tr>
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                                &nbsp;
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                            <td align="left" valign="top" colspan="2">
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                                    <input type="submit" name="button" id="button" value="Submit">
                                </label>
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                        </tr>
                    </table>
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