Common use of WITNESS my hand and official seal Clause in Contracts

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIIX, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIIX, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIVI, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIVI, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIV, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIV, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIIII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIIII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIX, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIX, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIIV, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIIIV, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT I, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment I, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT VI, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment VI, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT IV, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment IV, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL BROAD STREET INVESTMENT VII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital Broad Street Investment VII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24, 1999, of the common stock (the "Common Stock") of Providence Capital VIII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT V, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment V, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT II, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment II, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT III, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment III, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VIIBROAD STREET INVESTMENT VIII, INC. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24April 27, 19992001, of the common stock (the "Common Stock") of Providence Capital VIIBroad Street Investment VIII, Inc. (the "Company") a Colorado corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity:

WITNESS my hand and official seal. Notary Public My Commission Expires: EXHIBIT A PROVIDENCE CAPITAL VII, INCHISPANAMERICA CORP. CONFIDENTIAL INVESTOR QUESTIONNAIRE The Shares offered for sale pursuant to the registration exemption afforded by Rule 506 of the Act and accompanying Disclosure Document dated November 24August 20, 19992002, of the common stock (the "Common Stock") of Providence Capital VII, Inc. HispanAmerica Corp. (the "Company") a Colorado Delaware corporation, have not been registered under the Securities Act of 1933 (the "Act"), or under the securities laws of any state (the "State Acts"), and are being offered for sale and sold in reliance upon exemptions from the registration requirements of the Act and the State Acts. As a result, this Questionnaire must be completed by each potential investor in order to assist the Company in determining whether the offer for sale and sale of the Shares will qualify under such exemptions. All information furnished is for the use of the Company and its respective counsel and accountants. Such information will be held in confidence by such persons, except that this Confidential Investor Questionnaire may be furnished to such parties as the Company and its respective counsel and accountants deem necessary or desirable to establish compliance with federal or state securities laws. SPECIAL NOTE: CORPORATIONS, PARTNERSHIPS, TRUSTS, AND OTHER ENTITIES Subscribers which are corporations, partnerships, trusts, or other entities should have an authorized corporate officer, general partner, trustee, or other authorized representative complete Section I of this Confidential Investor Questionnaire, giving information concerning such representative, and may optionally complete Section II of the Confidential Investor Questionnaire giving information concerning the entity. In addition, the following information should be provided with respect to the entity: